Tobacco virus may be used to combat Parkinson's disease

A tobacco crop affected by drought. Courier-Journal photo
by David R. Lutman.

University of Louisville researchers say a virus that attacks tobacco plants may be used to develop a vaccine for Parkinson's disease.

The answer lies with the tobacco mosaic virus, which causes antibodies that "may be protective against Parkinson's," said Dr. Robert Friedland, a clinical and research neurologist at U of L.

Friedland's findings come after more than 60 studies have shown that smokers seem to have a reduced risk for developing Parkinson's, a motor system disorder that can cause tremors, stiffness and impaired balance. 

But Friedland and Dr. Honglei Chen, an investigator with the National Institute of Environmental Health Sciences, part of the National Institutes of Health, warn the findings should not be considered an excuse to smoke. Friedland's research is partly funded by the NIH, but not by any tobacco companies, reports Laura Ungar for The Courier-Journal. (Read more)

Lessons in battling obesity can be learned from the anti-tobacco movement, but there are big differences

To make real headway in battling the obesity epidemic, lessons can be learned from the war on smoking — though the two public-health issues have certain unique challenges. Judith Graham, reporting for Kaiser Health News in collaboration with USA Today, delves into the similarities and differences.

Her piece deserves to be read in its entirety, which can be done by clicking here, but here's a summary of her analysis:

Children are central. The majority of people start using tobacco as teenagers, with one-third of kids who smoke daily set to die prematurely of tobacco-related illnesses. Likewise, overweight children are at a greater risk of a vast array of health problems, including diabetes, liver disease and obesity in adulthood.

Protecting children as at the heart of both the anti-tobacco and anti-obesity efforts. "First let's protect our children," said Dr. David Ludwig, a child-obesity expert at Harvard Medical School. 

Changing social norms is the goal. While smoking in a hospital or airplane has become inconceivable, the same shift in social norms is required to fight childhood obesity. "Our (eating and physical activity) tastes, our preferences and our behaviors are learned and can be changed," said Dr. Jeffrey Koplan, former head of the Centers for Disease Control and Prevention and vice president for global health at Emory University in Atlanta. It won't be easy, but at least "we're dealing with a population that would like to be thinner and that works in our favor."

We can't "just say no" to food. "Tobacco we can get rid of entirely," said Dr. David Katz, director of Yale University's Prevention Research Center. "But we have to eat to live and make terms with food as the enemy."

That makes fighting childhood obesity much more difficult, since the message can't be "stop, don't do this." It has to instead be "make good choices, set boundaries," which is more difficult to convey and adhere to, Graham reports.

Our biology works against us. "While smoking is highly addictive, the biological responses attached to eating food are even more deeply rooted in human evolution," Graham reports. Evolutionarily speaking, humans are "built" to eat food when it's available and "we're very good at storing calories and defending calories once we've got them," said Dr. Stephen Daniels, chair of the department of pediatrics at the University of Colorado School of Medicine. 

Shame and denial are greater among the obese. A person's self-image is tightly tied to his or her body weight in a way that isn't true of smoking. That can provide a compelling reason to stop over-eating, but people don't tend to think of themselves as obese. "Obesity is seen as a pejorative term that people don't connect with," said Dr. William Dietz, director of the division of nutrition, physical activity and obesity at the CDC. "They think, 'I'm just 30 or 40 pounds overweight, but I'm not obese.'"

There are more food products available. "Tobacco is a single substance," Graham reports. "By contrast, the food and beverage industry is enormous and makes a huge array of goods that extend into every home, restaurant, convenience store, and grocery store in America."

There is no second-hand smoke equivalent. "The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people's intolerance of smoking and their willingness to see the government take action," said Michael Eriksen, director of the Institute of Public Health at Georgia State University. "Your being obese does not affect me in the same direct way."

The role of the food industry is less clear. While Big Tobacco was able to be demonized, "with obesity (as compared to tobacco) there's a much more nuanced relationship with industry," said Dr. James S. Marks, director of the health group at the Robert Wood Johnson Foundation.

Floyd County woman is Kentucky's smoke-free advocate of year

For her work spreading the word about second-hand smoke and founding the coalition that ultimately helped Prestonsburg pass a smoke-free ordinance in 2009, Floyd County's Jean V. Rosenberg was named 2012 advocate of the year at the annual Smoke-Free Policy Conference hosted by the University of Kentucky's Kentucky Center for Smoke-Free Policy. She stands with center Director Dr. Ellen Hahn, left, and Dr. Melissa Walton-Shirley, right, the Glasgow cardiologist who won in 2011.

Rosenberg started her work in 2005 when she began working for the Floyd County Health Department as a program specialist to increase awareness about the dangers of second-hand smoke, reports Ann Blackford reports in a university press release. During that time, she founded the Breathe Easy Floyd County Coalition, which educated people about second-hand smoke and supported local smoke-free initiatives.

On Nov. 1, 2009, the City of Prestonsburg implemented a 100 percent smoke-free ordinance in all workplaces and enclosed public places, with Rosenberg at the helm to propel the effort forward. (Read more)

Obesity adds more health-care costs than smoking, study finds

Obesity costs the health care system more than smoking does, a new study has found. The annual health costs for someone who is obese average $1,850 more than for a person a normal weight. The excess costs were up to $5,500 per year for people who are morbidly obese. Smokers' health costs averaged $1,275 more than those of nonsmokers.

Researchers studied the additional costs "of smoking and obesity among more than 30,000 Mayo Clinic employees and retirees. All had continuous health insurance coverage between 2001 and 2007," reports research-reporting service Newswise. The findings were published in the Journal of Occupational and Environmental Medicine.

The additional costs associated with obesity appeared to be lower after they were adjusted for other related health problems. "This may lead to underestimation of the true incremental costs, since obesity is a risk factor for developing chronic conditions," said James P. Moriary and his fellow researchers. (Read more)

Norton and UK HealthCare formalize the collaboration they announced almost a year and a half ago

UK HealthCare and Norton Healthcare have formalized the collaboration they announced almost a year and a half ago and will "focus on creating collaborations with hospitals across the state in stroke, cardiovascular and cancer care," Dr. Michael Karpf, executive vice president for health affairs at the University of Kentucky, announced today.

Said Steve Williams, president and CEO of Norton: "Our intent is to bring our combined health care expertise and resources into communities across the commonwealth to improve health-care outcomes."

The partnership will be in the form of a non-profit organization. The board of the Norton-UK HealthCare Partnership for Quality has already approved a budget of $595,000 to grow stroke outreach and education and launch programs to fight heart attacks and cancer, a press release says.

In late 2010, the two systems joined forces to create a statewide collaboration that addresses Kentucky's major health issues, including cancer, stroke and heart disease that stem from high obesity and smoking rates. Some of the accomplishments since the agreement include a transplant program, an effort to increase the number of obstetricians statewide; pharmacy education; and cancer care.

A competing collaboration, between the University of Louisville, Jewish Hospital and the Lexington-based St. Joseph Health System, is again trying to formalize its arrangement following rejection of a merger by state officials on grounds that University Hospital was a public institution that could not be bound by the Catholic system's restrictions on reproductive care.

Smoking ban bill clears House committee for first time; but sponsor says she won't take it farther this session

A measure for a statewide smoking ban passed the House Health and Welfare Committee today, the first time such a bill has cleared committee in legislative history, Deborah Yetter reports for The Courier-Journal.

But House Bill 289 is not expected to be called for a vote this year, said its sponsor Rep. Susan Westrom, right, D-Lexington. "I'm not someone who wants to shove something down someone's throat," she said, adding she plans to reintroduce the measure next year.

Westrom predicts support will continue to grow as "people come to realize local smoking bans have worked well in cities, including Louisville, Lexington and Owensboro. Already, 23 states ban smoking statewide in indoor public spaces," Yetter reports.

Support for the bill was given a significant boost when the Kentucky Chamber of Commerce stepped behind it. President David Adkisson said the majority of business owners the chamber talked to support a ban. "We now feel like it needs to be statewide and not a patchwork," he said.

HB 289 passed with a 10-2 vote. Rep. Addia Wuchner, R-Burlington, a candidate for Congress in the Fourth District, was one of two Republicans to vote against the measure, calling it "well meaning" but too intrusive on people's rights. "It is not the role of the government to go this far," she said. (Read more)

Number of teens and young adults who smoke, use smokeless tobacco is on the rise

A "shocking" number of American teenagers smoke cigarettes and/or use smokeless tobacco, the first U.S. surgeon general's report on youth tobacco since 1994 has found. (Photo by Karen Bleier, AFP/Getty Images)

"The numbers are really shocking," Surgeon General Regina Benjamin said, noting the data show 1 in 4 high school seniors and 1 in 3 young adults under age 26 smoke. "It's a problem we have to solve."

Though there was dramatic progress in reducing youth smoking rates from 1997 to 2003, the 899-page report shows the decline has flattened. "Smokeless tobacco is up among white high school-age boys, and cigar smoking appears to be rising among black high school girls," reports David Brown for The Washington Post.

Data from the 2010 Kentucky Youth Tobacco Survey show that almost 25 percent of the state's high-school students are smokers. Although the prevalence of smoking among youth has declined in the past few years, the smoking prevalence among teenagers and young adults is higher than among other adult populations.

"Two people start smoking for every one who dies from the habit each year," Benjamin said. "Almost 90 percent of those 'replacement smokers' first try tobacco before they are 18."

The findings showed smoking can damage lung function at a very young age. One study of "nearly 700 children from East Boston found that those who started to smoke at age 15 exhaled 8 percent less air in one second — a key measure of lung function — than non-smoking teenagers. The growth of lung capacity stopped a year earlier in smokers — at 17 in girls and 19 in boys — than in non-smokers," Brown reports.

Another study showed how smoking affects the cardiovascular system. Researchers looked at autopsy results of white men ages 25 to 34 who were killed either by trauma or homicide. Smokers were two times as likely to have advanced damage of the abdominal aorta as non-smokers. "They also had somewhat greater damage to the blood vessel most often implicated in acute heart attacks," Brown reports.

Danny McGoldrick of the Campaign for Tobacco-Free Kids told USA Today's Wendy Koch tobacco marketing "is a big cause of the problem." He pointed to his organization's report revealing the tobacco industry's relationship with convenience stores to blatantly advertise and display tobacco products.

The industry's success in fighting increases in tobacco-related taxes is considered to be another factor. But industry officials like Ken Garcia of Altria Group, parent company of Philip Morris USA, said "there's already quite a (tax) burden on adult smokers." (Read more)

Kentucky ranks next to last, Fifth Congressional District dead last in national healthiness and happiness survey

(Click on images for larger versions)

Kentucky was again next to last among the states in happiness and healthiness of its residents in 2011, ranking above only West Virginia, though precise rankings are uncertain. Eastern Kentucky's Fifth Congressional District ranked at the very bottom of the 436 districts — falling in last place in the categories of life evaluation, emotional health and physical health.

The Gallup-Healthways Well-Being Index is based on a continuing national survey that asks respondents about their overall sense of well-being, physical health, happiness, job satisfaction and other factors related to quality of life.

Of the 190 cities ranked, Lexington was 95th and Louisville 152nd. Kentucky's well-being score was 63.3 out of a possible 100 points. Hawaii again ranked first, at 70.2. West Virginia's score was 62.3. Because there were fewer than 10 points between first and last place, the rankings are not precise. Kentucky ranked lowest in the country in emotional health, which is based on feelings of happiness and sadness. Respondents were also asked about "physical health (chronic health conditions, obesity); lifestyle behaviors (smoking, diet and exercise); emotional health (feelings of happiness, sadness); work environment (relationship with supervisors); basic access (health care, food); and life evaluation (how they rate their lives)," reports Nanci Hellmich of USA Today.

Results were based on telephone interviews conducted between Jan. 2 and Dec. 29, 2011, producing a random sample of 353,492 adults. The margin of sampling error for most states is plus or minus 1 to 2 percentage points, but as high as plus or minus 4 points for states with small populations such as Wyoming, North Dakota, South Dakota, Delaware and Hawaii. (Read more)

Judge continues to block graphic images on cigarette packs

Getting graphic labels on cigarette packages continues to be an uphill battle for the Obama administration, as a skeptical judge sided with cigarette makers who say "they can't be forced to spread the government's anti-smoking advocacy with 'massive shocking, gruesome warnings' on products they legally sell," reports The Associated Press.

U.S. District Judge Richard Leon of Washington, D.C., has already decided that the cigarette makers will probably succeed in their lawsuit, because he has ordered the government to not enforce the requirement that the labels appear on cigarette packages next year.

The labels, approved by the Food and Drug Administration, "included color images of a man exhaling cigarette smoke through a tracheotomy hole in his throat; a plume of cigarette smoke enveloping an infant receiving a mother's kiss; a pair of diseased lungs next to a pair of healthy lungs; a diseased mouth afflicted with what appears to be cancerous lesions; a man breathing into an oxygen mask," among others, AP reports.

Leon has indicated he thinks the labels go overboard in their efforts to convey the dangers of cigarettes. He has ruled they are too large; they were intended to cover the top half of packs. "It sounds like they are headed to a place," he said Wednesday, "where you have to watch a 10-minute video before you can even buy a pack of cigarettes." (Read more)

Should companies refuse to hire employees who smoke? Opposing views outlined

The growing controversy surrounding companies who refuse to hire employees who smoke is featured in two opposing opinion pieces in USA Today.

Paul Terpeluk, medical director of employee health services at Cleveland Clinic, explains why the policy makes sense for his company. "Consider that cigarette smoke contains hundreds of chemicals and compounds that are toxic and at least 69 that cause cancer," he writes. "To ignore this would be to undermine our commitment to health and wellness, which includes providing a healthy environment for our employees, visitors and patients. Plus, the policy has not proved to be an overwhelming obstacle for job applicants. Since it was instituted, less than 2 percent of job offers — about 300 out of 20,000 — have been rescinded due to positive nicotine tests." (Read more)

But a USA Today editorial expresses a different view, in response to Baylor Health Care System's move to stop hiring workers who smoke. "Intruding this deeply into people's privates lives raises questions that bear scrutiny," it reads. "Companies can charge smokers more for health coverage or ban smoking on the job. But punishing people for using a legal product on their own time crosses a troubling line."

The editorial makes an exception for health-care companies who want to practice what they preach. "But such practices are not confined to the health care industry, and they raise a broader issue: If employers routinely reject people who engage in risky, but legal, behavior on their own time, what about such things are overeating or drinking too much alcohol?" (Read more)

In 11-1 vote, Somerset passes comprehensive smoking ban

Lighting up in Somerset, once a big tobacco town, will no longer be allowed in all enclosed public places. The city council voted 11-1 Monday evening to pass a smoking-ban ordinance, reports Heather Tomlinson of the Commonwealth Journal. (C-J photo)

The ordinance includes restaurants, bingo halls, gaming facilities, nursing homes and any place of employment. "It's a public health safety issue," said councilor Jerry Girdler, who lost his well-known brother Eddie two weeks ago to throat and lung cancer. "The facts back up that smoking is harmful to the people around them."

The meeting attracted a crowd of more than 50, many of whom voiced their opinions. Business owner Teresa Singleton said, "I am really shocked at the fact that the City of Somerset is considering taking away the rights of businesses to make those decisions on whether we want our place of business to be smoking or non-smoking. For you to take that on your own, I think that's a major step in the wrong direction."

Local podiatrist Pamela Jensen-Stanley disagreed. "I believe the ban is necessary," she said. "I think it's time that Somerset moves up and gets with the program." (Read more)

Rockcastle County school board nixes ban on smoking at schools

While more than 30 Kentucky communities have banned smoking in enclosed public places, and about as many school districts have imposed a total ban, many districts remain resistant to the idea. This month the Rockcastle County Board of Education turned down a smoking ban that would have allowed designated smoking areas at athletic events but no smoke breaks for employees.

"Four of the five board members expressed opposition to the ban, including Mike Burdette, who said he didn't feel it was right to tell an adult they cannot use a legal product on grounds their taxes pay for," reported  the Mount Vernon Signal. Other board members said they didn't like the fact that the proposal from the administration did not include smoke breaks since employees "can't leave school during the day except for designated reasons."

The Signal reported that Superintendent Larry Hammond "put forth the argument that research has shown that second- and even third-hand smoke can be harmful to students," but only Board Chairman Martin Vanzant supported the proposal. To a member who suggested that the ban be delayed for two or three years, he said that would be "postponing the inevitable." (Read more)

In Kentucky, "All 174 school systems have restrictions of some sort on the use of tobacco products on their campuses, and any that allow staff smoking have designated areas," Brad Hughes of the Kentucky School Boards Association told Kentucky health News. "About 30 have a total ban."

Spend $1 on smoking cessation, save $3 in health costs, Massachusetts study finds

Every $1 spent on smoking cessation in Massachusetts, saved $3 in health costs, a study of low-income Bay State residents found. That could bode well for the impact of a new smoking-cessation benefit in Kentucky's Medicaid program.

Massachusetts added a smoking-cessation benefit to its Medicaid program in 2006 and "let members choose from any FDA-approved options," reports Martha Bebinger for National Public Radio.

Researchers at George Washington University "found that members who quit saved three times the cost of the program in fewer heart-related hospitalizations after just over one year," Bebinger reports. "The study does not take into account the benefits of avoiding cancer or other long term smoking related illnesses."

Kentucky ranked 36th in the nation for tobacco prevention spending. Though it received $389 million in tobacco-settlment funds in fiscal year 2012, and ranks first or second in tobacco use, Kentucky spent just $2.2 million of that on prevention of tobacco use. It recently added a smoking-cessation benefit to Medicaid, a program that is funded mainly by the federal government but administered by individual states.

Some employers stop hiring smokers in effort to 'walk the walk'

As smoking bans become more common nationwide, employers are taking it one step further and refusing to hire people who smoke. Primarily in hospitals, employers "won't hire applicants whose urine tests positive for nicotine use, whether cigarettes, smokeless tobacco or even patches," reports Wendy Koch of USA Today.

"We have to walk the walk if we talk the talk," said David Fotsch of Idaho's Central District Health Department, whose board agreed to stop hiring smokers last month.

"We're trying to promote a complete culture of wellness," said Mary Marshall of the Geisinger Health System in Danville, Pa., which likewise stopped hiring smokers. "We're not denying smokers their right to tobacco products. We're just choosing not to hire them."

As for how many U.S. businesses are opting not to hire smokers, there is no data but "the trend appears strongest with hospitals," Koch reports.

Critics say the practice is the equivalent of employment discrimination. "It's a very dangerous precedent," said Michael Siegel, a professor at Boston University's School of Public Health.

"What's next? Are you not going to hire overly-caffeinated people," said Nate Shelman, Boise's KBOI radio talk show host. "I'm tired of people seeing smokers as an easy piñata."

But federal laws do not view the move as discrimination because smokers are not recognized as a protected class. Still, 29 states, including Kentucky, as well as the District of Columbia, have passed smoker-protection laws.

Paul Billings of the American Lung Association said he is not convinced that refusing to hire people who smoke will help them quit — smoking cessation programs probably are more effective, he thinks — but the ALA nevertheless opts not to hire them. "We're non-smoking exemplars," he said. (Read more)

Smoking hookahs can cause carbon monoxide poisoning

Though they're often viewed as just cool and unusual, hookahs, exotic-looking water pipes that can be smoked at several restaurants and bars in Lexington and Louisville, can cause carbon-monoxide poisoning.

That was the case with a young man who was brought to Jewish Hospital in Louisville last fall after passing out, reports Joseph Lord of The Courier-Journal. His symptoms indicated carbon monoxide poisoning, but doctors were confused by its source. After more research, they determined it was from a hookah. His monoxide level was tested at about 29 percent. A cigarette smoker can have a level of about 5 percent. (Photo of Amanda Steinhauer and Don Moore by Aaron Borton) "They're the levels we're used to seeing when you have furnace issues, house fires, car in the garage — the really significant carbon-monoxide poisonings," said Henry Spiller, director of the Kentucky Regional Poison Center.

The increased level is not entirely surprising, given that research shows the average cigarette smoker takes about 10 puffs per cigarette, while a hookah session might involve 100 puffs. Data from the Centers for Disease Control and Prevention show a one-hour hookah session involves the user inhaling 100 to 200 times the volume of smoke than would be inhaled from one cigarette.

Symptoms of carbon-monoxide poisoning include nausea and fatigue. Long-term health problems can include neurological damage. (Read more)

State health department starts new ad campaign against secondhand smoke, including three 15-second TV commercials

The Kentucky Department for Public Health is launching a new campaign to educate Kentuckians about the dangers of secondhand tobacco smoke and its potential effect. The campaign is funded by $281,000 from the economic stimulus package of 2009 and about $90,000 from the federal Centers for Disease Control and Prevention. This week the department will start running television, billboard and radio advertisements to show the dangers of smoke that comes from the burning end of cigarette, cigar or pipe or the exhaled smoke from a smoker. The ads, which will run statewide, highlight the link between secondhand smoke and dangerous illnesses in both adults and children.



The ads, produced by Louisville-based Doe-Anderson, feature people being unwillingly exposed to secondhand smoke in places such as residences and cars. Each ad carries the tag line, “Secondhand smoke is 100 percent unsafe, 100 percent of the time.”

Kentucky’s smoking rate remains the second highest in the country, with 24.8 percent of the adult population identified as current smokers, and secondhand smoke exposure is equally high. The health department says 39.5 percent of Kentucky children live with someone who smokes – the highest percentage in the country. Secondhand smoke has become a major public health concern because it contains approximately 4,000 chemicals, many of which are known carcinogens, and is responsible for approximately 3,000 cases of lung cancer deaths among nonsmokers each year.



The campaign is another project of the Kentucky Tobacco Prevention and Cessation program. Community interventions for tobacco cessation are available through local health departments staffed with tobacco control specialists, and the program operates a toll-free telephone line, 1-800-QUIT NOW. It also provides technical assistance, with the Kentucky Center for Smoke Free Policy at the University of Kentucky, to assist communities in seeking smoke-free ordinances.

Most Kentuckians now favor statewide smoking ban, poll finds

Graph shows results by smoking history, party

Just over half of Kentuckians support a statewide law that would ban smoking in most public places, including restaurants and bars, the Kentucky Health Issues Poll has found.

Just under 53 percent said they were in favor of such a law, and another 1 percent said they lean toward favoring it. Only 40.5 percent opposed the idea, with 2 percent leaning against it. Four percent had no opinion.

Including leaners, the law was favored by 53.7 percent to 42.5 percent, a double-digit margin. Last year, Kentuckians were split down the middle, 48 percent to 48 percent. The poll's error margin is plus or minus 2.44 percentage points, meaning that each figure could vary that much from actual public opinion in 19 of 20 cases. It could vary more in one out of 20.

The poll was released yesterday by the Foundation for a Healthy Kentucky. It asked 1,614 Kentuckians, "Would you favor or oppose a state law in Kentucky that would prohibit smoking in most public places, including workplaces, public buildings, offices, restaurants and bars?" The detailed results were: 40.9 percent favored strongly, 11.8 percent favored somewhat, 11.5 percent opposed somewhat and 29 percent opposed strongly.

Despite those strong views, there was again no split along party lines; 55 percent of Democrats and 55 percent of Republicans were supportive of a ban and independents were slightly less so. As was the case last year, respondents who are registered to vote were more likely to support a smoke-free law, with six in 10 in favor.

Respondents in the Lexington area showed the strongest level of support, with nearly 57 percent of people living there either strongly or somewhat in favor of passing a statewide ban.

Interestingly, respondents living in Appalachian Kentucky — which historically has very high smoking rates — also expressed strong support, with 53.4 percent in favor, plus or minus 4.96 percentage points. (The poll groups counties by area development districts; Appalachian Kentucky was defined as counties in ADDs that are mainly Appalachian, in green on the map.)

Despite Campbell County overturning its smoking ban earlier this year and controversy surrounding the ban in Kenton County, which is the only county in the region with a ban, respondents in Northern Kentucky showed the third highest level of support for a statewide law, with 52.9 percent in favor. The error margin for that small sample of 152 was plus or minus 7.95 percentage points.

In Louisville, 52.4 percent favored the law, plus or minus 5.26 percentage points. Western Kentucky had the lowest level of support, with 49.5 percent in favor and 47.1 percent opposed, plus or minus 4.63 percentage points. The poll included the Lincoln Trail Area Development District, generally recognized as part of the Louisville region, as part of Western Kentucky.

The issue is most strongly supported by non-smokers. Of respondents who have never smoked, 3 in 4 are in favor of a smoke-free law. Fifty-seven percent of respondents who are former smokers were in favor. When it came to smokers, just 3 in 10 support a law. For tables showing the detailed poll results, click here.

The poll, which was funded by the Foundation for a Healthy Kentucky and The Health Foundation of Greater Cincinnati, was conducted Sept. 27 to Oct. 27 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,614 adults across Kentucky were interviewed, including 1,313 landline interviews and 308 cell-phone interviews. For more from the Foundation for a Healthy Kentucky, click here.

Teens turning to flavored cigars

A study shows teens are dispensing with cigarettes and turning to flavored mini-cigars with fun flavors — strawberry, chocolate, vanilla — enticing to young palates. (National Cigar Museum picture) "Young smokers say these cigarette-size little cigars and cigarillos — slimmer versions of big cigars — look better and can be bought one at a time instead of spending more than $5 for a pack of cigarettes," writes Lena H. Sun of The Washington Post. "Many teens also think that they are less addictive."

After cigarettes, cigar smoking is the second most common tobacco product used by youth nationwide, according to the Centers for Disease Control and Prevention. About 14 percent of high school students smoke them (18.6 percent among boys and 8.8 percent among girls). Though the Food and Drug Administration banned flavored cigarettes in 2009, it did not apply to cigars. They are only available to adults 18 and older, but many stores in Kentucky do not ask for ID.

In many states, mini cigars are taxed less than cigarettes. Federal excise tax is about 39 cents on a pack of 20 cigarettes. The tax on cigars that are the size of cigarettes is 4 cents for a pack of 20. In Kentucky, the tax rate on a pack of 20 cigarettes is 60 cents. Other tobacco products, including cigars, are taxed 15 percent.

While more enticing and less expensive, they are just as dangerous as cigarettes. "You have the same cancer-causing chemicals but wrapped in flavors that don't let you experience the harsh sensation of cigar or tobacco use," said Donald Shell, interim director for Maryland's Center for Health Promotion, Education, Tobacco Use Prevention and Cessation. (Read more For a fact sheet on mini-cigars, on the Kentucky Cabinet for Health and Family Services' website, click here.

Kentucky is 43rd among the states in health rankings report

Kentucky is near the bottom of the list in a ranking that determines which states are the healthiest. It came in 43rd, up from 44th last year.

Kentucky's low ranking is attributed to its unusually high numbers of people who smoke, are obese, die of cancer and are hospitalized for preventable reasons, according to America's Health Rankings, funded by the United Health Foundation.

"As it has for the last decade, Mississippi was ranked 50th on this year's list, which was topped by Vermont at No. 1," Louisville's Business First reports.

"Kentucky's rank of 43rd is a reminder that, while are making progress, as Kentuckians we still have much to do to keep ill health from holding us down," said Susan Zepeda, president/CEO of the Foundation for a Healthy Kentucky. "The good news is there are many concerned civic leaders working to reduce rates of smoking and obesity in the state and keep young people from starting to smoke."

Highlights of the report show:

• While smoking has decreased from 30.5 percent to 24.8 percent of Kentucky adults in the past 10 years, 822,000 still smoke. Recently, Kentucky ranked 36th in the nation for its smoking cessation efforts.

• Almost 1.1 million Kentuckians are obese, 353,000 more than 10 years ago.

• Diabetes decreased from 11.5 percent to 10 percent of the populations in the past year, but there are still 322,000 adults in Kentucky with diabetes.

• In the past five years, the percentage of people without health insurance increased from 13 percent to 15.4 percent.

• In the past 10 years, the percentage of children living in poverty increased from 15.2 percent to 24.7 percent.

As for the entire country, overall health has not improved this year over 2010. "Between 1990 and 2000, the overall health of the nation ... improved by an average of 1.6 percent each year. After 2000, however, the upward trend slowed to 0.5 percent annually," until this year, Health.com reports.

"Physical activity, nutrition, and tobacco: If we could get people focused on those three, we could take a huge bite out of the chronic-disease epidemic," said Georges Benjamin, the executive director of American Public Health Association. "This is not an infinite list of things that people have to address."

America's Health Rankings has been assessing health data for the past 22 years, making it the longest-running health assessment report in the country. For its methodology, researchers look at four groups of health determinants: behaviors, such as smoking and obesity rates; community and environment, such as children living in poverty, violent crime and infectious disease; public and health policies, such as lack of health insurance and public health funding; and clinic care, such as prenatal care, the number of primary care physician and preventable hospitalization rates.

Each of these four determinants are intimately connected with one other, researchers contend. "For example, an initiative that addresses tobacco cessation requires not only efforts on the part of the individual but also support from the community in the form of public and health policies that promote non-smoking and the availability of effective counseling and care at clinics," the report reads.

Data sources include the Centers for Disease Control and Prevention; American Medical Association; Federal Bureau of Investigation; U.S. Census Bureau; and National Center for Health Statistics.

Kentucky ranks 36th for tobacco prevention spending; many states have made cuts

Though it received $389 million in tobacco-settlement funds in fiscal year 2012, and ranks first or second in tobacco use, Kentucky spent just $2.2 million of that on prevention of tobacco use. The figures rank Kentucky 36th in the nation for helping its residents stop smoking or using smokeless tobacco.

The findings come from a report called "A Broken Promise to Our Children: The 1998 State Tobacco Settlement 13 Years Later," which was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society and other non-profit groups. The "promise" in the settlement among cigarette makers and state attorneys general was not specific, but strongly implied.

The report found that the Centers for Disease Control and Prevention recommend Kentucky spend $57.2 million each year to establish a comprehensive tobacco prevention program. But while Kentucky does not come close to that figure, most states don't either and have cut tobacco prevention spending even more in 2012 in the face of budget deficits, The Associated Press reports.

"There are no easy cuts anymore. There's the old expression, tried and true, it's not fat anymore, we're talking about bone," said Debra Miller, director of health policy for the Council of State Governments. "All revenue is looked at as revenue for the highest priority programs ... They aren't ignoring the whole idea of tobacco cessation and the public health issues, the budgets are just such a problem right now."

States have cut their funding 12 percent this year, putting it at its lowest level since 1999, AP reports.

Kentucky is one of 33 states that is spending less than a quarter of the amount recommended by the CDC. Only Alaska is meeting or exceeding the recommendation. Connecticut, Nevada, New Hampshire, Ohio and the District of Columbia did not put any funds into tobacco prevention in 2012. Kentucky cut its tobacco prevention spending by $400,000 from fiscal year 2011. In the past four years, states have cut funding by 36 percent.

About 46 million Americans smoke, while more than 3 percent of American adults use smokeless tobacco, according to the CDC. A recent poll found Kentucky has the highest smoking rate in the country, with 29 percent of people surveyed in a Gallup-Healthways Well-Being Index poll answering "yes" to the question. To find county-specific smoking rates, click here. (Read more)