Don't get burned, bitten or bamboozled this summer; here are safety tips for dealing with the sun, insects and sales pitches

By Molly Burchett
Kentucky Health News

Summer is finally here, and after one of the coldest Kentucky springs, who doesn't want to be outside swimming, skiing, fishing, barbecuing or soaking up rays on the beach? While summer may bring much-anticipated fun in the sun, it's important to take some  safety precautions to make sure you and your family are not getting too much of a good thing.

Sunscreen can protect you from cancer, but don't spray it

The sun is bad for your skin, and exposure to its harmful ultraviolet (UV) rays can increase your risk for skin cancer, which is the most common cancer in the U.S., says the federal Centers for Disease Control and Prevention. It's critical to protect yourself and your children from sun damage because just one blistering sunburn in childhood more than doubles the odds of developing skin cancer later in life, says the Mayo Clinic.

Fortunately, it’s never too late or too early to lessen your risk of sun damage by using sunscreen, and the Environmental Working Group has recently released its 2013 Guide to Sunscreens, which rates more than 1,400 sunscreens, lip balms, and SPF moisturizers and cosmetics for safety and effectiveness.

This year, EWG says 184 sunscreens, 25 percent of those on the market, met its criteria of offering adequate UV protection and posing few safety concerns. You can click here to view that product list, or here to check out the EWG findings for moisturizers, lip balm and makeup.

EWG also created a somewhat surprising list of things NOT to bring on vacation because they are unsafe or do not provide adequate UV protection:

• Spray sunscreen: These sprays may pose serious inhalation risks, and they make it too easy to not apply enough sunscreen or to miss a spot.
• High-SPF sunscreens: These products may tempt people to stay in the sun too long, which can increase the risk of other kinds of skin damage, and EWG recommends that consumers avoid products labeled higher than SPF 50.
• Oxybenzone: Used in half of sunscreen products, this chemical penetrates the skin and can adversely impact health in several ways; in the body, it acts like the female hormone estrogen and can cause allregic reactions.
• Loose powder sunscreen: Tiny zinc particles in these products can also end up in your lungs when you breathe them in during application, which irritates the lungs.
• Retinyl palmitate: Some sunscreens contain this chemical, which is a form of vitamin A, but when applied to sun-exposed skin, it may speed development of skin tumors and lesions.
• Combined sunscreen/bug repellents: Studies show this combination leads to increased skin absorption of the repellent ingredients.
• Sunscreen towelettes: Whether they really work is unknown.
• Tanning oils: They are simply a bad idea and can ultimately lead to behavior that increases risk of developing skin cancer.

So, check the ingredients for your sunscreen, avoid high-SPF's or sprays and make it a habit to wear sunscreen during sports or whenever you're outside. Be sure to reapply often to ensure UV protection, particularly if you get wet or sweaty. Click here to read EWG's "Nine Surprising Facts about Sunscreen."

Hats and clothing: Choose the right kind

Children are more vulnerable to sun damage, so in addition to actual sunscreen, the best sun protections for them are a hat and shirt (which also protect adults). The CDC recommends avoiding straw hats that let sun through the holes, and to wear a hat with UV protection or a wide brim to shield the face, head, ear and neck. If you do chose to wear a baseball cap, protect your ears and neck with clothing, sunscreen (with at least SPF 15) or spend lots of time in shade.

Wear clothing to protect exposed skin. The CDC says loose-fitting long-sleeved shirts and long pants made from tightly woven fabric offer the best UV protection. Darker colors may offer more protection than lighter colors, and a wet t-shirt offers much less UV protection that a dry one.

Sunburn treatment: People with fair skin or light-colored hair are more likely to be sunburned. If you get sunburned, remember that "The skin heals but is forever damaged," writes University of Kentucky nursing Professor Mollie Aheshire. "The more frequent and more severe the burns, the more damage there is," along with risk for cancer and premature aging. "If a sunburn is blistering and covers a large portion of your body; is accompanied by a high fever, extreme pain, confusion, nausea or chills; or does not respond to at-home treatment within a few days . . . see a health-care provider." Mild sunburns can be treated with over-the-counter pain relievers, cold compresses and moisturizing creams — aloe vera or hydrocortisone lotions. "If blisters form, do not break them," Aheshire writes. "Drink plenty of fluids to prevent dehydration. Treat peeling skin gently. Stay out of the sun until redness and pain resolve." (Read more)

Sunglasses: Not just to help you see now, but to keep you seeing longer

Besides being dangerous for your skin, UV rays are dangerous to your eyes and can cause vision disorders, premature aging of the eyes or even blindness. It is important to wear sunglasses to protect eyes from sun damage, although a new survey from the American Optometric Association shows that only 40 percent of consumers cite this protection as the primary reason for wearing sunglasses, says a Kentucky Optometric Association press release.

To help reduce the risks of harmful UV exposure on the eyes, children and adults should start wearing protective sunglasses as as early as possible, and parents should ensure that babies are protected by sunglasses too, says the release. When choosing sunglasses or protective contact lenses, make sure that they block more than 95 percent of UV-A and more than 99 percent of UV-B radiation, says the KOA, and sunglasses should have a frame that fits close to the eyes so the UV rays can't sneak around the sides.

Insect repellent: Bugs can bug you, but don't over-react to them

Although nothing can ruin a relaxing summer picnic faster than bugs, take precautions to ensure you're using the right type of bug repellent-- one that's been approved by the Environmental Protection Agency -- and that you're using it wisely.

Not only are bugs annoying, they can also carry dangerous diseases, and for the safe and effective use bug repellents, always read the product label before using the product, EPA says. It says to follow these bug-repellent safety tips:

• Repellents should be applied only to exposed skin and/or clothing. Do not use them under clothing.
• Store insect repellents safely out of the reach of children.
• Do not apply near eyes and mouth, and be use sparingly around the ears.
• When using sprays, spray on the hands first and then apply to the face, not directly to the face.
• Never use repellents over cuts, wounds or irritated skin.
• Do not spray in enclosed areas and avoid spraying near food.
• After returning indoors, wash treated skin and clothes with soap and water.
• Do not use any product on pets or other animals
• Most insect repellents do not work on lice or fleas. 
• Click here to search for a repellent that's right for you.

Beware if you want to use a wearable repellent that's not sticky and has to be continuously resprayed, such as Off!'s clip-on mosquito repellent. It works once the cloud of mosquito protection is built around the wearer, says Brighid Moret of The Washington Times, but it's not a good option for an active or young child. The manufacturer warns on the label that a chemical on the product's enclosed disk is harmful if swallowed, directly inhaled or absorbed through the skin, and young children should not wear it.

Whether you're going on vacation or a "stay-cation," these tips can help protect you and your family from the sun and bugs in order to safely make the most of your summer. Click here for more sun safety tips from EWG.

By Molly Burchett
Kentucky Health News

Summer is finally here, and after one of the coldest Kentucky springs, who doesn't want to be outside swimming, skiing, fishing, barbecuing or soaking up rays on the beach? While summer may bring much-anticipated fun in the sun, it's important to take some  safety precautions to make sure you and your family are not getting too much of a good thing.

Sunscreen can protect you from cancer, but don't spray it

The sun is bad for your skin, and exposure to its harmful ultraviolet (UV) rays can increase your risk for skin cancer, which is the most common cancer in the U.S., says the federal Centers for Disease Control and Prevention. It's critical to protect yourself and your children from sun damage because just one blistering sunburn in childhood more than doubles the odds of developing skin cancer later in life, says the Mayo Clinic.

Fortunately, it’s never too late or too early to lessen your risk of sun damage by using sunscreen, and the Environmental Working Group has recently released its 2013 Guide to Sunscreens, which rates more than 1,400 sunscreens, lip balms, and SPF moisturizers and cosmetics for safety and effectiveness.

This year, EWG says 184 sunscreens, 25 percent of those on the market, met its criteria of offering adequate UV protection and posing few safety concerns. You can click here to view that product list, or here to check out the EWG findings for moisturizers, lip balm and makeup.

EWG also created a somewhat surprising list of things NOT to bring on vacation because they are unsafe or do not provide adequate UV protection:

• Spray sunscreen: These sprays may pose serious inhalation risks, and they make it too easy to not apply enough sunscreen or to miss a spot.
• High-SPF sunscreens: These products may tempt people to stay in the sun too long, which can increase the risk of other kinds of skin damage, and EWG recommends that consumers avoid products labeled higher than SPF 50.
• Oxybenzone: Used in half of sunscreen products, this chemical penetrates the skin and can adversely impact health in several ways; in the body, it acts like the female hormone estrogen and can cause allregic reactions.
• Loose powder sunscreen: Tiny zinc particles in these products can also end up in your lungs when you breathe them in during application, which irritates the lungs.
• Retinyl palmitate: Some sunscreens contain this chemical, which is a form of vitamin A, but when applied to sun-exposed skin, it may speed development of skin tumors and lesions.
• Combined sunscreen/bug repellents: Studies show this combination leads to increased skin absorption of the repellent ingredients.
• Sunscreen towelettes: Whether they really work is unknown.
• Tanning oils: They are simply a bad idea and can ultimately lead to behavior that increases risk of developing skin cancer.

So, check the ingredients for your sunscreen, avoid high-SPF's or sprays and make it a habit to wear sunscreen during sports or whenever you're outside. Be sure to reapply often to ensure UV protection, particularly if you get wet or sweaty. Click here to read EWG's "Nine Surprising Facts about Sunscreen."

Hats and clothing: Choose the right kind

Children are more vulnerable to sun damage, so in addition to actual sunscreen, the best sun protections for them are a hat and shirt (which also protect adults). The CDC recommends avoiding straw hats that let sun through the holes, and to wear a hat with UV protection or a wide brim to shield the face, head, ear and neck. If you do chose to wear a baseball cap, protect your ears and neck with clothing, sunscreen (with at least SPF 15) or spend lots of time in shade.

Wear clothing to protect exposed skin. The CDC says loose-fitting long-sleeved shirts and long pants made from tightly woven fabric offer the best UV protection. Darker colors may offer more protection than lighter colors, and a wet t-shirt offers much less UV protection that a dry one.

Sunburn treatment: People with fair skin or light-colored hair are more likely to be sunburned. If you get sunburned, remember that "The skin heals but is forever damaged," writes University of Kentucky nursing Professor Mollie Aheshire. "The more frequent and more severe the burns, the more damage there is," along with risk for cancer and premature aging. "If a sunburn is blistering and covers a large portion of your body; is accompanied by a high fever, extreme pain, confusion, nausea or chills; or does not respond to at-home treatment within a few days . . . see a health-care provider." Mild sunburns can be treated with over-the-counter pain relievers, cold compresses and moisturizing creams — aloe vera or hydrocortisone lotions. "If blisters form, do not break them," Aheshire writes. "Drink plenty of fluids to prevent dehydration. Treat peeling skin gently. Stay out of the sun until redness and pain resolve." (Read more)

Sunglasses: Not just to help you see now, but to keep you seeing longer

Besides being dangerous for your skin, UV rays are dangerous to your eyes and can cause vision disorders, premature aging of the eyes or even blindness. It is important to wear sunglasses to protect eyes from sun damage, although a new survey from the American Optometric Association shows that only 40 percent of consumers cite this protection as the primary reason for wearing sunglasses, says a Kentucky Optometric Association press release.

To help reduce the risks of harmful UV exposure on the eyes, children and adults should start wearing protective sunglasses as as early as possible, and parents should ensure that babies are protected by sunglasses too, says the release. When choosing sunglasses or protective contact lenses, make sure that they block more than 95 percent of UV-A and more than 99 percent of UV-B radiation, says the KOA, and sunglasses should have a frame that fits close to the eyes so the UV rays can't sneak around the sides.

Insect repellent: Bugs can bug you, but don't over-react to them

Although nothing can ruin a relaxing summer picnic faster than bugs, take precautions to ensure you're using the right type of bug repellent-- one that's been approved by the Environmental Protection Agency -- and that you're using it wisely.

Not only are bugs annoying, they can also carry dangerous diseases, and for the safe and effective use bug repellents, always read the product label before using the product, EPA says. It says to follow these bug-repellent safety tips:

• Repellents should be applied only to exposed skin and/or clothing. Do not use them under clothing.
• Store insect repellents safely out of the reach of children.
• Do not apply near eyes and mouth, and be use sparingly around the ears.
• When using sprays, spray on the hands first and then apply to the face, not directly to the face.
• Never use repellents over cuts, wounds or irritated skin.
• Do not spray in enclosed areas and avoid spraying near food.
• After returning indoors, wash treated skin and clothes with soap and water.
• Do not use any product on pets or other animals
• Most insect repellents do not work on lice or fleas. 
• Click here to search for a repellent that's right for you.

Beware if you want to use a wearable repellent that's not sticky and has to be continuously resprayed, such as Off!'s clip-on mosquito repellent. It works once the cloud of mosquito protection is built around the wearer, says Brighid Moret of The Washington Times, but it's not a good option for an active or young child. The manufacturer warns on the label that a chemical on the product's enclosed disk is harmful if swallowed, directly inhaled or absorbed through the skin, and young children should not wear it.

Whether you're going on vacation or a "stay-cation," these tips can help protect you and your family from the sun and bugs in order to safely make the most of your summer. Click here for more sun safety tips from EWG.

Read More

At least one in eight teens, and perhaps one in five, have a mental-health issue; ADHD tops, substance abuse also high

The most comprehensive report yet on mental disorders in children shows attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed problem in those aged 3-17, and the most common health issues for teenagers include addiction to drugs, alcohol and tobacco.

An estimated 13 to 20 percent of U.S. children experience a mental disorder in a given year, says a new report by the Centers for Disease Control and Prevention, and children are increasingly suffering from and being hospitalized for mood disorders like depression; that hospitalization rate has increased 80 percent from 1997 to 2010, says the report. And, while 3.5 percent of children under 18 have behavioral problems, almost 7 percent of them are diagnosed with ADHD.

About 4.7 percent of teens, or 1.7 million children aged 12–17, have disorders involving abuse and dependence upon alcohol, drugs or tobacco, says the report. Alarmingly, two-thirds of teenagers had an illicit drug use disorder, one million teenagers abused drugs or alcohol, and more than 695,000 were addicted to tobacco.

“This first report of its kind documents that millions of children are living with depression, substance use disorders, ADHD and other mental health conditions,” CDC Director Dr. Tom Frieden said. “No parent, grandparent, teacher or friend wants to see a child struggle with these issues. It concerns us all. We are working to both increase our understanding of these disorders and help scale up programs and strategies to prevent mental illness so that our children grow to lead productive, healthy lives.”

The most comprehensive report yet on mental disorders in children shows attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed problem in those aged 3-17, and the most common health issues for teenagers include addiction to drugs, alcohol and tobacco.

An estimated 13 to 20 percent of U.S. children experience a mental disorder in a given year, says a new report by the Centers for Disease Control and Prevention, and children are increasingly suffering from and being hospitalized for mood disorders like depression; that hospitalization rate has increased 80 percent from 1997 to 2010, says the report. And, while 3.5 percent of children under 18 have behavioral problems, almost 7 percent of them are diagnosed with ADHD.

About 4.7 percent of teens, or 1.7 million children aged 12–17, have disorders involving abuse and dependence upon alcohol, drugs or tobacco, says the report. Alarmingly, two-thirds of teenagers had an illicit drug use disorder, one million teenagers abused drugs or alcohol, and more than 695,000 were addicted to tobacco.

“This first report of its kind documents that millions of children are living with depression, substance use disorders, ADHD and other mental health conditions,” CDC Director Dr. Tom Frieden said. “No parent, grandparent, teacher or friend wants to see a child struggle with these issues. It concerns us all. We are working to both increase our understanding of these disorders and help scale up programs and strategies to prevent mental illness so that our children grow to lead productive, healthy lives.”

Read More

W. Va. plans private-public model to provide school breakfast, improve child health, fight obesity; could this approach help Ky.?

By Molly Burchett
Kentucky Health News

Breakfast has been said to be the most important meal of the day, and it can be important in fighting obesity. Policymakers in West Virginia are pushing for breakfast food programs in schools through public-private partnerships, and a new report says similar programs could save $41 billion in federal dollars long-term by preventing obesity. Does this make sense, and does it make sense for Kentucky?

Like West Virginia, Kentucky has a high obesity rate among middle and high school students but has many children who don't always get the food they need to live a healthy life. Kentucky ranks fourth highest in food insecurity among children because 23 percent of Kentucky's children do not always know where they will find their next meal, according to Feeding America’s "Map the Meal Gap" study. (Here's a link to its interactive map, where you can see food insecurity rates by county in order to find out more about your county. One example appears below; orange dots are headquarters of regional food banks.)

A recent bill passed by West Virginia lawmakers addresses the problems of food insecurity, obesity and education simultaneously and serves as the first example for a statewide public-private funding partnership to improve school meals programs, reports David Gutman of The Associated Press. The bill would also require every county to set up a fund to collect private food donations.

The bill aims to require every school to have breakfast food programs so no student goes without it because of costs, says Gutman. Poor nutrition and diet are sometimes issues of cost and income level since healthy foods can be more expensive than unhealthy ones. For example, a bag of 10 apples may costs $4.99, but a package of Little Debbie oatmeal creme pies could be $1.79. A medium-sized apple has 93 calories and less than 1 gram of fat while an oatmeal creme pie has 318 calories and 13 grams of fat.

What does this have to do with obesity? The research-based logic is that a healthy, daily breakfast improves diet and can replace sugary alternatives such as donuts. Eating a healthy breakfast also improves education by combating hunger and aiding concentration and has been found to be associated with overall health and mental functioning. Overall, these factors may work together to improve education and diet, reports Gutman.

Such a program could help Kentucky address the state's problems related to food insecurity, obesity and education, while generating long-term savings. Similar food programs that provide meals to low-income children could generate as much as $41 billion in long-term federal saving by preventing obesity, says a new report from the Campaign to End Obesity.

The report says that the S-CHIP childhood obesity demonstration project, which combines changes in preventive care with community and school efforts to reduce childhood obesity in low-income communities, could prevent a child from becoming obese, saving an estimated $41,500 for an average female and $30,600 for an average male Medicaid beneficiary, says the report.

Three other programs were highlighted as huge cost-savers because they would prevent obesity and related chronic conditions in the long run, which would reduce health care costs and increase wages, says the report. These include increasing obesity screenings by physicians, bringing the Diabetes Prevention Program to scale and covering certain weight loss drugs under Medicare Part D. Preventive health policies aimed at obesity prevention could significantly reduce government expenditures, could save tax dollars and could improve the overall health of Kentuckians.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

By Molly Burchett
Kentucky Health News

Breakfast has been said to be the most important meal of the day, and it can be important in fighting obesity. Policymakers in West Virginia are pushing for breakfast food programs in schools through public-private partnerships, and a new report says similar programs could save $41 billion in federal dollars long-term by preventing obesity. Does this make sense, and does it make sense for Kentucky?

Like West Virginia, Kentucky has a high obesity rate among middle and high school students but has many children who don't always get the food they need to live a healthy life. Kentucky ranks fourth highest in food insecurity among children because 23 percent of Kentucky's children do not always know where they will find their next meal, according to Feeding America’s "Map the Meal Gap" study. (Here's a link to its interactive map, where you can see food insecurity rates by county in order to find out more about your county. One example appears below; orange dots are headquarters of regional food banks.)

A recent bill passed by West Virginia lawmakers addresses the problems of food insecurity, obesity and education simultaneously and serves as the first example for a statewide public-private funding partnership to improve school meals programs, reports David Gutman of The Associated Press. The bill would also require every county to set up a fund to collect private food donations.

The bill aims to require every school to have breakfast food programs so no student goes without it because of costs, says Gutman. Poor nutrition and diet are sometimes issues of cost and income level since healthy foods can be more expensive than unhealthy ones. For example, a bag of 10 apples may costs $4.99, but a package of Little Debbie oatmeal creme pies could be $1.79. A medium-sized apple has 93 calories and less than 1 gram of fat while an oatmeal creme pie has 318 calories and 13 grams of fat.

What does this have to do with obesity? The research-based logic is that a healthy, daily breakfast improves diet and can replace sugary alternatives such as donuts. Eating a healthy breakfast also improves education by combating hunger and aiding concentration and has been found to be associated with overall health and mental functioning. Overall, these factors may work together to improve education and diet, reports Gutman.

Such a program could help Kentucky address the state's problems related to food insecurity, obesity and education, while generating long-term savings. Similar food programs that provide meals to low-income children could generate as much as $41 billion in long-term federal saving by preventing obesity, says a new report from the Campaign to End Obesity.

The report says that the S-CHIP childhood obesity demonstration project, which combines changes in preventive care with community and school efforts to reduce childhood obesity in low-income communities, could prevent a child from becoming obese, saving an estimated $41,500 for an average female and $30,600 for an average male Medicaid beneficiary, says the report.

Three other programs were highlighted as huge cost-savers because they would prevent obesity and related chronic conditions in the long run, which would reduce health care costs and increase wages, says the report. These include increasing obesity screenings by physicians, bringing the Diabetes Prevention Program to scale and covering certain weight loss drugs under Medicare Part D. Preventive health policies aimed at obesity prevention could significantly reduce government expenditures, could save tax dollars and could improve the overall health of Kentuckians.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Read More

Parents should talk to children about alcohol; study shows teens do listen

Two recent studies highlight how important it is for parent to talk with their teens about the risks of alcohol use, which leads to more than 4,500 deaths nationwide every year.

In the first study, Mothers Against Drunk Driving found that fewer than a third of alcohol-related deaths among 15- to 20-year-olds are caused by drinking and driving. About 32 percent of the drinking-related deaths involved traffic crashes, while 68 percent involved incidents such as murder (30 percent), suicide (14 percent), alcohol poisoning (9 percent) and other causes (15 percent), MADD says in a press release.

"These data show that taking away the keys truly does not take away all of the risks when it comes to underage drinking," MADD national president Jan Withers said. "MADD hopes this information will inspire parents to have ongoing conversations with their kids about the dangers of drinking alcohol before age 21, especially since we know that a majority of kids say their parents are the biggest influence on their decisions about alcohol."

Another study says parents can help reduce children's excessive drinking in college by talking with them about the potential dangers of excessive drinking before they set foot on campus, and it turns out that children really do listen to their parents about drinking, says the study by Rob Turrisi of Penn State. Discussing drinking in any way before teens go to campus, including why some teens drink while others don't, as well as the potential dangers of excessive drinking, can help.

Having this type of conversation with teens about the reality of underage drinking and its risks, such as alcoholism and alcohol poisoning, and can reduce the odds that light drinkers will escalate into excessive drinkers, says the study. It can also increase the likelihood that already heavy-drinking teens cut down on their drinking or even stop completely.

The National Institute on Alcohol Abuse and Alcoholism also urges parents to talk with their children about alcohol. Click here for more information about doing this or to read about the risks of alcohol use and other prevention strategies.

Two recent studies highlight how important it is for parent to talk with their teens about the risks of alcohol use, which leads to more than 4,500 deaths nationwide every year.

In the first study, Mothers Against Drunk Driving found that fewer than a third of alcohol-related deaths among 15- to 20-year-olds are caused by drinking and driving. About 32 percent of the drinking-related deaths involved traffic crashes, while 68 percent involved incidents such as murder (30 percent), suicide (14 percent), alcohol poisoning (9 percent) and other causes (15 percent), MADD says in a press release.

"These data show that taking away the keys truly does not take away all of the risks when it comes to underage drinking," MADD national president Jan Withers said. "MADD hopes this information will inspire parents to have ongoing conversations with their kids about the dangers of drinking alcohol before age 21, especially since we know that a majority of kids say their parents are the biggest influence on their decisions about alcohol."

Another study says parents can help reduce children's excessive drinking in college by talking with them about the potential dangers of excessive drinking before they set foot on campus, and it turns out that children really do listen to their parents about drinking, says the study by Rob Turrisi of Penn State. Discussing drinking in any way before teens go to campus, including why some teens drink while others don't, as well as the potential dangers of excessive drinking, can help.

Having this type of conversation with teens about the reality of underage drinking and its risks, such as alcoholism and alcohol poisoning, and can reduce the odds that light drinkers will escalate into excessive drinkers, says the study. It can also increase the likelihood that already heavy-drinking teens cut down on their drinking or even stop completely.

The National Institute on Alcohol Abuse and Alcoholism also urges parents to talk with their children about alcohol. Click here for more information about doing this or to read about the risks of alcohol use and other prevention strategies.

Read More

New website for after-school programs promotes 'Drink Right, Move More and Snack Smart' to fight childhood obesity

To combat the country's childhood obesity epidemic, ChildObesity180, a new initiative from Tufts University, has launched Healthy Kids Hub, a website with resources for out-of-school-time programs, encouraging kids to develop and adopt three universal nutrition and physical activity principles: "Drink Right, Move More and Snack Smart."

The Hub offers free activity, nutrition and equipment support to volunteers, coaches and leaders in out-of-school-time programs, which serve tens of millions of children and have been identified as a promising area for obesity prevention efforts, the site says.

In Kentucky, almost 18 percent of middle-school-age children and 16 percent of elementary-age kids are obese, says a recent report from the University of Kentucky's College of Public Health.

Research shows that foods and beverages, as well as opportunities for physical activity, vary greatly in out-of-school programs, so the Hub promotes greater consistency in such programs and provides resources to help children follow healthy habits while out of school.

The website was launched at the National Afterschool Association convention in Indianapolis last week, according to a release. Visitors to the website can complete a brief survey to get resources tailored to their specific needs. Click here for the website.

To combat the country's childhood obesity epidemic, ChildObesity180, a new initiative from Tufts University, has launched Healthy Kids Hub, a website with resources for out-of-school-time programs, encouraging kids to develop and adopt three universal nutrition and physical activity principles: "Drink Right, Move More and Snack Smart."

The Hub offers free activity, nutrition and equipment support to volunteers, coaches and leaders in out-of-school-time programs, which serve tens of millions of children and have been identified as a promising area for obesity prevention efforts, the site says.

In Kentucky, almost 18 percent of middle-school-age children and 16 percent of elementary-age kids are obese, says a recent report from the University of Kentucky's College of Public Health.

Research shows that foods and beverages, as well as opportunities for physical activity, vary greatly in out-of-school programs, so the Hub promotes greater consistency in such programs and provides resources to help children follow healthy habits while out of school.

The website was launched at the National Afterschool Association convention in Indianapolis last week, according to a release. Visitors to the website can complete a brief survey to get resources tailored to their specific needs. Click here for the website.

Read More

To keep kids from getting fat, use smaller plates and portions, limit TV viewing and make sure they get 10 hours of sleep a night

Kentucky ranks high in child obesity. Parents can make sure their children maintain a healthy weight with three simple suggestions highlighted in recent studies: Serve them meals on smaller, child-size plates, pay attention to what they watch on TV, and make sure they get enough sleep.

In Kentucky, almost 18 percent of middle-school-age children and 16 percent of elementary-age kids are obese, and every third child born who was in the U.S. in 2000 will develop Type 2 diabetes if current trends continue, says a recent report from the University of Kentucky's College of Public Health.

The three suggestions are based on three new studies in the April issue of Pediatrics.

One study found first-graders served themselves larger food portions and consumed almost 50 percent of the extra calories they put on their plates when using adult-sized dinner plates instead of child-sized salad plates, reports Michelle Healy of USA Today.
A second study examined the relationship between heavy use of media  and increased body mass index,  a measure based on height and weight that can classify someone as being overweight or obese. It found that TV usage is the most problematic and leads to higher BMI scores, reports Healy. One reason for this may be that TV advertising includes commercials for unhealthy snack foods. Or, perhaps kids are missing out on exercise because they watch so much TV. 

A new sleep study adds to research saying that insufficient sleep may contribute to the rise in adolescent obesity because it changes hormone levels that could lead to overeating and weight gain, reports Healy.

These findings support existing recommendations to help children attain and keep a healthy weight according the UK report. Portion sizes should be a third of adult portions for younger children and two-thirds of adult portions for older children; children's TV screen time should be limited to two hours per day; and children should get 10 hours of sleep each night.

Kentucky ranks high in child obesity. Parents can make sure their children maintain a healthy weight with three simple suggestions highlighted in recent studies: Serve them meals on smaller, child-size plates, pay attention to what they watch on TV, and make sure they get enough sleep.

In Kentucky, almost 18 percent of middle-school-age children and 16 percent of elementary-age kids are obese, and every third child born who was in the U.S. in 2000 will develop Type 2 diabetes if current trends continue, says a recent report from the University of Kentucky's College of Public Health.

The three suggestions are based on three new studies in the April issue of Pediatrics.

One study found first-graders served themselves larger food portions and consumed almost 50 percent of the extra calories they put on their plates when using adult-sized dinner plates instead of child-sized salad plates, reports Michelle Healy of USA Today.
A second study examined the relationship between heavy use of media  and increased body mass index,  a measure based on height and weight that can classify someone as being overweight or obese. It found that TV usage is the most problematic and leads to higher BMI scores, reports Healy. One reason for this may be that TV advertising includes commercials for unhealthy snack foods. Or, perhaps kids are missing out on exercise because they watch so much TV. 

A new sleep study adds to research saying that insufficient sleep may contribute to the rise in adolescent obesity because it changes hormone levels that could lead to overeating and weight gain, reports Healy.

These findings support existing recommendations to help children attain and keep a healthy weight according the UK report. Portion sizes should be a third of adult portions for younger children and two-thirds of adult portions for older children; children's TV screen time should be limited to two hours per day; and children should get 10 hours of sleep each night.

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It's Autism Awareness Month; do you know the warning signs?

The University of Kentucky hosted the state's first Light It Up Blue event by illuminating Memorial Hall with blue lights on April 2nd, and this event is a unique global initiative that kicks-off Autism Awareness Month and helps raise awareness about autism.

This is the sixth year for Light It Up Blue, but the Autism Society has been celebrating National Autism Awareness Month since the 1970's in order to highlight the need for awareness about autism. Autism is increasing in prevalence, and according to a recent report by the Centers for Disease Control and Prevention, 1 in 50 school-age children in the United States has autism; that number increased from 1 in 88 in 2012.

Autism is defined by a certain set of behaviors and is a spectrum disorder that affects individuals differently. Typically, autism appears during the first three years of life and affects a person’s ability to communicate and interact with others, says the CDC. While there is no known single cause of autism, it is treatable, and studies show that early diagnosis and intervention lead to significantly improved outcomes for families.

With individualized interventions, says the CDC, parents can minimize challenges their child faces. From birth to 5 years, children should reach certain milestones in how he or she plays, learns, speaks and acts, and delays in any of these areas could be a sign of a developmental problem. Therefore, it is important to talk to a doctor as soon as possible children display some of the warning signs below.

From the CDC's Learn the Signs, Act Early campaign

Kentucky is one of 12 states with existing autism care insurance requirements, meaning that private insurance must cover autism treatment. Fortunately, there are many treatment options for autism in Kentucky that can generally be divided into four categories: behavioral and communication approaches, dietary approaches, medication and alternative medicine approaches. Click here for a full list of treatment resources or here for more Autism signs and symptoms.

In addition to when a parent is concerned, the American Academy of Pediatrics recommends that children be screened for general development using standardized, validated tools at 9, 18, and 24 or 30 months and for autism at 18 and 24 months. While autism spectrum disorders occur in all racial, ethnic and socioeconomic groups, they are almost five times more common among boys than girls, says the CDC.

In order to make sure your child reaches his or her full potential, it is very important to get help as soon as possible if your child shows concerning symptoms, according to the CDC's Learn the Signs, Act Early campaign.

The University of Kentucky hosted the state's first Light It Up Blue event by illuminating Memorial Hall with blue lights on April 2nd, and this event is a unique global initiative that kicks-off Autism Awareness Month and helps raise awareness about autism.

This is the sixth year for Light It Up Blue, but the Autism Society has been celebrating National Autism Awareness Month since the 1970's in order to highlight the need for awareness about autism. Autism is increasing in prevalence, and according to a recent report by the Centers for Disease Control and Prevention, 1 in 50 school-age children in the United States has autism; that number increased from 1 in 88 in 2012.

Autism is defined by a certain set of behaviors and is a spectrum disorder that affects individuals differently. Typically, autism appears during the first three years of life and affects a person’s ability to communicate and interact with others, says the CDC. While there is no known single cause of autism, it is treatable, and studies show that early diagnosis and intervention lead to significantly improved outcomes for families.

With individualized interventions, says the CDC, parents can minimize challenges their child faces. From birth to 5 years, children should reach certain milestones in how he or she plays, learns, speaks and acts, and delays in any of these areas could be a sign of a developmental problem. Therefore, it is important to talk to a doctor as soon as possible children display some of the warning signs below.

From the CDC's Learn the Signs, Act Early campaign

Kentucky is one of 12 states with existing autism care insurance requirements, meaning that private insurance must cover autism treatment. Fortunately, there are many treatment options for autism in Kentucky that can generally be divided into four categories: behavioral and communication approaches, dietary approaches, medication and alternative medicine approaches. Click here for a full list of treatment resources or here for more Autism signs and symptoms.

In addition to when a parent is concerned, the American Academy of Pediatrics recommends that children be screened for general development using standardized, validated tools at 9, 18, and 24 or 30 months and for autism at 18 and 24 months. While autism spectrum disorders occur in all racial, ethnic and socioeconomic groups, they are almost five times more common among boys than girls, says the CDC.

In order to make sure your child reaches his or her full potential, it is very important to get help as soon as possible if your child shows concerning symptoms, according to the CDC's Learn the Signs, Act Early campaign.

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Legislature eases physician assistant rules; nurse practitioners' prescription power, Medicaid prompt-payment bills, others linger

By Molly Burchett and Al Cross
Kentucky Health News

The Kentucky General Assembly has joined other states in easing the restrictions on physician assistants’ medical practice, but has held up a similar move for advanced registered nurse practitioners. Both issues relate to the shortage of medical practitioners in many Kentucky counties, and the quality of medical care.

The Senate added the physician assistant language of Senate Bill 43 to House Bill 104, an art-therapy bill, in order to preserve an agreement between the Kentucky Medical Association and the Kentucky Academy of Physician Assistants. It will repeal the law that bans PAs from practicing for their first 18 months unless a physician is on site; one will still have to be available by telephone. The amended bill has been sent to Gov. Steve Beshear for his signature or veto.

The amendment was used because the House had tacked onto SB 43 an amendment from advance practice registered nurses that would have repealed the need for them to have a collaborative agreement with a physicians to prescribe non-narcotic drugs. The KMA opposes that idea.

"It's looking like the doctors win," said Sen. Julie Denton, R-Louisville, who favors the repeal. "I'm not hopeful" it can pass, she said, but added that some physicians also favor it: "With Obamacare coming in, we're going to need all the front-line physicians we can get." Leading opponents of the measure, Republicans Katie Stine of Fort Thomas and Carroll Gibson of Leitchfield, didn't return a call seeking comment.

Nurse practitioners say that SB 43 is necessary to allow them to fill health-care gaps in rural Kentucky and address the state's shortage of primary-care providers. The Kentucky Coalition of Nurse Practitioners and Nurse Midwives says in an article prepared for Kentucky newspapers that NPs have never been required to practice under physician supervision and 17 states allow full prescribing authority for non-scheduled medications.

The Medicaid prompt-payment bill, HB 5, went to a conference committee after the House refused to go along with Senate changes, and may be considered when the legislature returns later this month, ostensibly to consider any bills Beshear vetoes. The bill would apply prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

In the final crunch to pass legislation before the veto recess, lawmakers attached seven health care-related bills to HB 366, which had focused on identifying congenital heart disease in newborns. It had 10 additional measures "hung on it like a Christmas tree before the free conference committee of House and Senate members," reports Ryan Alessi of cn|2's "Pure Politics."

The bills still hanging on the measure, dubbed the "healthy Christmas tree," are:

• HB 187, addressing a free prescription-drug program for under-insured Kentuckians.
• HB 79, which would exempt licensed health care providers from being disciplined for prescribing naloxone in the event of an overdose.
• HB 387, which aims to provide nutritional supplements for low-birth-weight newborns.
• SB 201, which addresses licensed diabetes educators.
• SB 38, to require Medicaid to accept provider credentialing by a Medicaid managed-care organization.
• SB 108, relating to managed-care contracts with the IMPACT Plus program, a behavioral health program for children.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

By Molly Burchett and Al Cross
Kentucky Health News

The Kentucky General Assembly has joined other states in easing the restrictions on physician assistants’ medical practice, but has held up a similar move for advanced registered nurse practitioners. Both issues relate to the shortage of medical practitioners in many Kentucky counties, and the quality of medical care.

The Senate added the physician assistant language of Senate Bill 43 to House Bill 104, an art-therapy bill, in order to preserve an agreement between the Kentucky Medical Association and the Kentucky Academy of Physician Assistants. It will repeal the law that bans PAs from practicing for their first 18 months unless a physician is on site; one will still have to be available by telephone. The amended bill has been sent to Gov. Steve Beshear for his signature or veto.

The amendment was used because the House had tacked onto SB 43 an amendment from advance practice registered nurses that would have repealed the need for them to have a collaborative agreement with a physicians to prescribe non-narcotic drugs. The KMA opposes that idea.

"It's looking like the doctors win," said Sen. Julie Denton, R-Louisville, who favors the repeal. "I'm not hopeful" it can pass, she said, but added that some physicians also favor it: "With Obamacare coming in, we're going to need all the front-line physicians we can get." Leading opponents of the measure, Republicans Katie Stine of Fort Thomas and Carroll Gibson of Leitchfield, didn't return a call seeking comment.

Nurse practitioners say that SB 43 is necessary to allow them to fill health-care gaps in rural Kentucky and address the state's shortage of primary-care providers. The Kentucky Coalition of Nurse Practitioners and Nurse Midwives says in an article prepared for Kentucky newspapers that NPs have never been required to practice under physician supervision and 17 states allow full prescribing authority for non-scheduled medications.

The Medicaid prompt-payment bill, HB 5, went to a conference committee after the House refused to go along with Senate changes, and may be considered when the legislature returns later this month, ostensibly to consider any bills Beshear vetoes. The bill would apply prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

In the final crunch to pass legislation before the veto recess, lawmakers attached seven health care-related bills to HB 366, which had focused on identifying congenital heart disease in newborns. It had 10 additional measures "hung on it like a Christmas tree before the free conference committee of House and Senate members," reports Ryan Alessi of cn|2's "Pure Politics."

The bills still hanging on the measure, dubbed the "healthy Christmas tree," are:

• HB 187, addressing a free prescription-drug program for under-insured Kentuckians.
• HB 79, which would exempt licensed health care providers from being disciplined for prescribing naloxone in the event of an overdose.
• HB 387, which aims to provide nutritional supplements for low-birth-weight newborns.
• SB 201, which addresses licensed diabetes educators.
• SB 38, to require Medicaid to accept provider credentialing by a Medicaid managed-care organization.
• SB 108, relating to managed-care contracts with the IMPACT Plus program, a behavioral health program for children.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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Improving Kentucky's mental health calls for the action of schools and doctors to identify children's mental health needs early

Many people may think that addressing mental health needs in Kentucky relies mostly on more funding, but its effectiveness hinges more on the ability to identify children who need help and make sure they get it early, two experts said on cn|2's "Pure Politics" Tuesday.

About half of mental illnesses begin to appear before a person turns 14, reports cn|2's Ryan Alessi. Mental-health experts say it’s often more effective and efficient to treat children, and it’s easier for parents to make sure their children get help than it is for someone to convince or coerce an adult exhibiting symptoms that he needs treatment, said Dr. Allen Brenzel, a child psychiatrist.


Encouraging school officials and doctors to identify children with these needs can be a challenge, Brenzel said, because it is difficult for a teacher to have tough conversations with parents about this topic. Also, while doctors may be most important in this process, obstacles exist because our current "system of care doesn't promote the amount of time and effort and importance on these issues," he said.

When a primary-care doctor's offices are jammed with sick patients and a parent comes in to discuss problems their child is having in school, "That’s a challenging environment in primary care,” Brenzel said. “But people trust their primary care providers very often, and that is where they go. So some of what we need to look at is co-location of services.”

Brenzel said we need a system with a single point of access, where a family can be greeted, there is a period of engagement and a reimbursement structure that supports the time and efforts required by behavioral health.

"We need to integrate behavioral health into the overall health care system," he said. "We have a very fragmented and inefficient system that leads to confusion when a family identifies that their child needs help and this isn't going to be fixed by a medical model.  We now know that the kinds of services need to be much more comprehensive and supportive. A system that allows a comprehensive mental and behavioral health assessment of needs will allow us to triage many kids out of the juvenile justice system."

Benzel said this is a societal issue and for every $1 that we spend in supportive services, we can avoid spend $5 later on adult incarcerations and adult prison. On average, it was more than $2,000 cheaper per person to treat a child than an adult. It amounted to $4,328 per child compared to more than $6,500 for each adult treated, Alessi reports.

Families may be fearful of the cost of mental-health services, but there are resources for people without mental-health insurance coverage at the 14 mental health centers in Kentucky, said Steve Shannon, executive director of the Kentucky Association of Mental Health/Mental Retardation Programs.

In terms of resources, Kentucky spent nearly a half billion dollars on mental health for people under 21 in the 2010-11 fiscal year. For adults, the state spent more than $730 million, according to figures from the Cabinet for Health and Family Services. (Read more)

Many people may think that addressing mental health needs in Kentucky relies mostly on more funding, but its effectiveness hinges more on the ability to identify children who need help and make sure they get it early, two experts said on cn|2's "Pure Politics" Tuesday.

About half of mental illnesses begin to appear before a person turns 14, reports cn|2's Ryan Alessi. Mental-health experts say it’s often more effective and efficient to treat children, and it’s easier for parents to make sure their children get help than it is for someone to convince or coerce an adult exhibiting symptoms that he needs treatment, said Dr. Allen Brenzel, a child psychiatrist.


Encouraging school officials and doctors to identify children with these needs can be a challenge, Brenzel said, because it is difficult for a teacher to have tough conversations with parents about this topic. Also, while doctors may be most important in this process, obstacles exist because our current "system of care doesn't promote the amount of time and effort and importance on these issues," he said.

When a primary-care doctor's offices are jammed with sick patients and a parent comes in to discuss problems their child is having in school, "That’s a challenging environment in primary care,” Brenzel said. “But people trust their primary care providers very often, and that is where they go. So some of what we need to look at is co-location of services.”

Brenzel said we need a system with a single point of access, where a family can be greeted, there is a period of engagement and a reimbursement structure that supports the time and efforts required by behavioral health.

"We need to integrate behavioral health into the overall health care system," he said. "We have a very fragmented and inefficient system that leads to confusion when a family identifies that their child needs help and this isn't going to be fixed by a medical model.  We now know that the kinds of services need to be much more comprehensive and supportive. A system that allows a comprehensive mental and behavioral health assessment of needs will allow us to triage many kids out of the juvenile justice system."

Benzel said this is a societal issue and for every $1 that we spend in supportive services, we can avoid spend $5 later on adult incarcerations and adult prison. On average, it was more than $2,000 cheaper per person to treat a child than an adult. It amounted to $4,328 per child compared to more than $6,500 for each adult treated, Alessi reports.

Families may be fearful of the cost of mental-health services, but there are resources for people without mental-health insurance coverage at the 14 mental health centers in Kentucky, said Steve Shannon, executive director of the Kentucky Association of Mental Health/Mental Retardation Programs.

In terms of resources, Kentucky spent nearly a half billion dollars on mental health for people under 21 in the 2010-11 fiscal year. For adults, the state spent more than $730 million, according to figures from the Cabinet for Health and Family Services. (Read more)

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Ky. parents strongly favor increasing school dropout age, a step that could make future high-school students healthier

A statewide poll has found that Kentucky parents overwhelmingly favor increasing the state’s school dropout age, and doing so might help future high-school students' health, according to the Foundation for a Healthy Kentucky, which sponsored the poll.   

After being told the legislature may raise the dropout age to 18 from 16, 85 percent of Kentucky parents said they favor the move, and 77 percent of parents said they strongly favored it.

Besides their homes, school is where children spend most of their time, and the overall health and well-being of students affect their ability to learn.  Healthy kids learn better and students’ academic achievement in turn affects their ability to be healthy and stay well in the future.

“People may not realize that education is a health issue, but research tells us that completing high school is directly related to our health status in later life,” said Dr. Susan Zepeda, President and CEO of the foundation. “Increasing the dropout age is one strategy aimed at improving the graduation rate in the state. We hope this polling data will encourage a deeper conversation among parents, education experts and policy makers to explore this and other strategies to help our children succeed at school and lead a more healthy life.”

The dropout-age question was part of the Kentucky Parent Survey, which provided a snapshot of parental views on a number of issues involving health care, school and home life. It surveyed parents, step-parents, grandparents, foster parents or other legal guardians of children in Kentucky.

The poll was conducted in July and August 2012 by the Center for Survey Research at the University of Virginia.  More than 1,000 parents and guardians of children under 18 from throughout the state were interviewed by telephone, including landlines and cell phones.  The survey's margin of error is plus or minus 3 percentage points. 

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

A statewide poll has found that Kentucky parents overwhelmingly favor increasing the state’s school dropout age, and doing so might help future high-school students' health, according to the Foundation for a Healthy Kentucky, which sponsored the poll.   

After being told the legislature may raise the dropout age to 18 from 16, 85 percent of Kentucky parents said they favor the move, and 77 percent of parents said they strongly favored it.

Besides their homes, school is where children spend most of their time, and the overall health and well-being of students affect their ability to learn.  Healthy kids learn better and students’ academic achievement in turn affects their ability to be healthy and stay well in the future.

“People may not realize that education is a health issue, but research tells us that completing high school is directly related to our health status in later life,” said Dr. Susan Zepeda, President and CEO of the foundation. “Increasing the dropout age is one strategy aimed at improving the graduation rate in the state. We hope this polling data will encourage a deeper conversation among parents, education experts and policy makers to explore this and other strategies to help our children succeed at school and lead a more healthy life.”

The dropout-age question was part of the Kentucky Parent Survey, which provided a snapshot of parental views on a number of issues involving health care, school and home life. It surveyed parents, step-parents, grandparents, foster parents or other legal guardians of children in Kentucky.

The poll was conducted in July and August 2012 by the Center for Survey Research at the University of Virginia.  More than 1,000 parents and guardians of children under 18 from throughout the state were interviewed by telephone, including landlines and cell phones.  The survey's margin of error is plus or minus 3 percentage points. 

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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School nurses start getting scarcer, due to Medicaid problems

By Molly Burchett
Kentucky Health News

Students in many Kentucky counties will find it harder to see a school nurse due to changes in the state Medicaid program and lack of payment from managed-care companies.

Takirah Sleet, 7, and school nurse Michelle Marra looked at Takirah's
lunch tray to calculate her insulin dosage at Lansdowne Elementary
in Lexington. (Lexington Herald-Leader photo by Pablo Alcala)

In Crittenden County schools, budget woes have forced the Pennyrile District Health Department to request additional money from the school district to keep its school health clinics fully-staffed and open, reports Jason Travis of The Crittenden Press. Allison Beshear, director of the health department, told Travis one reason from the budget crunch is a lack of payment from Kentucky Spirit, which owes the health department $266,000.

Without additional money from the school district, Beshear says, the health department cannot maintain the current level of service at school clinics through the end of the school year.  Proposals have been made to offer services to the district that entail reducing clerical staff without reducing the number of nurses; but in order to do so, trained school staff would have to handle daily medication distribution and help to answer the phones for the clinic.

"Kentucky Spirit has filed two appeals with the Cabinet of Health Services and the Finance Cabinet in which it claims to not be financially responsible for healthcare given in school clinics," reports Drew Adams of WKMS-FM in Murray reports in a story about similar problems in Hopkins County.

Other school districts facing similar problems include those of Bell, Clark and Pike counties. Eleven school health clinics in Bell County could be shut down by the end of this school year, reports WBIR-TV of Knoxville. In Clark County, a lawsuit between the state and Kentucky Spirit has put a halt to reimbursement for health services provided in county schools, reports Rachel Gilliam of The Winchester Sun.

Last month, the Pike County Board of Health filed a lawsuit against Kentucky Spirit because the managed-care firm has stopped reimbursing the Board of Health for school-nurse programs, reports Jordan Vilines of WYMT-TV in Hazard. The money has to be reimbursed in order to provide school nurses.

“I think having someone in the school to ensure that our children are healthy is imperative for the quality of life of our kids, especially in a very rural area," Pike Judge-Executive Wayne T. Rutherford told Vilines.  He said that without reimbursement, school nurses could lose their jobs, which would leave hundreds of kids without immediate medical care.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Health Kentucky.

By Molly Burchett
Kentucky Health News

Students in many Kentucky counties will find it harder to see a school nurse due to changes in the state Medicaid program and lack of payment from managed-care companies.

Takirah Sleet, 7, and school nurse Michelle Marra looked at Takirah's
lunch tray to calculate her insulin dosage at Lansdowne Elementary
in Lexington. (Lexington Herald-Leader photo by Pablo Alcala)

In Crittenden County schools, budget woes have forced the Pennyrile District Health Department to request additional money from the school district to keep its school health clinics fully-staffed and open, reports Jason Travis of The Crittenden Press. Allison Beshear, director of the health department, told Travis one reason from the budget crunch is a lack of payment from Kentucky Spirit, which owes the health department $266,000.

Without additional money from the school district, Beshear says, the health department cannot maintain the current level of service at school clinics through the end of the school year.  Proposals have been made to offer services to the district that entail reducing clerical staff without reducing the number of nurses; but in order to do so, trained school staff would have to handle daily medication distribution and help to answer the phones for the clinic.

"Kentucky Spirit has filed two appeals with the Cabinet of Health Services and the Finance Cabinet in which it claims to not be financially responsible for healthcare given in school clinics," reports Drew Adams of WKMS-FM in Murray reports in a story about similar problems in Hopkins County.

Other school districts facing similar problems include those of Bell, Clark and Pike counties. Eleven school health clinics in Bell County could be shut down by the end of this school year, reports WBIR-TV of Knoxville. In Clark County, a lawsuit between the state and Kentucky Spirit has put a halt to reimbursement for health services provided in county schools, reports Rachel Gilliam of The Winchester Sun.

Last month, the Pike County Board of Health filed a lawsuit against Kentucky Spirit because the managed-care firm has stopped reimbursing the Board of Health for school-nurse programs, reports Jordan Vilines of WYMT-TV in Hazard. The money has to be reimbursed in order to provide school nurses.

“I think having someone in the school to ensure that our children are healthy is imperative for the quality of life of our kids, especially in a very rural area," Pike Judge-Executive Wayne T. Rutherford told Vilines.  He said that without reimbursement, school nurses could lose their jobs, which would leave hundreds of kids without immediate medical care.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Health Kentucky.

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Many Ky. parents don't realize children are overweight, or won't acknowledge it, but many report kids' poor health behavior

By Al Cross
Kentucky Health News

Many Kentucky parents don't realize that their children are obese or overweight, or at least aren't willing to acknowledge it. That is the obvious conclusion to draw from the latest results of the Kentucky Parent Survey, released Tuesday by the Foundation for a Healthy Kentucky.

The poll found that only 14 percent of Kentucky parents say their child weighs too much, but the National Survey of Children's Health found that 37 percent of Kentucky children are overweight or obese. Conversely, 76 percent of parents in the poll think their child's weight is about right, but the national survey found that only 58 percent of Kentucky kids have healthy weight.

The Kentucky Parent survey, taken by land-line and cell telephone from July 19 to Aug. 22 by the Center for Survey Research at the University of Virginia, interviewed 1,006 Kentucky parents, step-parents, grandparents, foster parents or other legal guardians of children in Kentucky selected at random. The statistical margin of error for that sample size is plus or minus 3 percentage points.

The poll also found that 56 percent of Kentucky children are watching more than the maximum daily recommended amount of “screen time” – watching television, playing video games or using the Internet – and that 59 percent drink sugar-sweetened beverages every day. Both are major factors in childhood obesity, research has found, and experts recommend no more than two hours of screen time a day and no sugar-sweetened drinks at all.

“Parents can help reduce this risk by encouraging healthy behaviors for their children,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky.“Our children’s habits and behaviors impact their health today and shape their quality of life as they grow. When kids eat poorly and don’t get enough physical activity, it increases their risk for obesity, diabetes, heart disease and other chronic diseases. This poll data helps us understand what parents think about the behaviors that are so critical to health.”

The Kentucky Parent Survey also found that only 56 percent of Kentucky parents said their child got "enough" fruits and vegetables every day during the preceding week, and 66 percent of parents reported their child got "enough" physical activity every day during the preceding week. It also found that elementary and high-school students often get less than the recommended amount of sleep per day (chart).

The survey did not define "enough." The foundation noted that one strategy to reduce childhood obesity in Kentucky is "5-2-1-0," reflecting experts' recommendations that each day, children should eat at least five servings of fruits and vegetables, have no more than two hours of screen time, engage in one hour of physical activity, and drink zero sugar-sweetened beverages. For the foundation's press release, click here.

By Al Cross
Kentucky Health News

Many Kentucky parents don't realize that their children are obese or overweight, or at least aren't willing to acknowledge it. That is the obvious conclusion to draw from the latest results of the Kentucky Parent Survey, released Tuesday by the Foundation for a Healthy Kentucky.

The poll found that only 14 percent of Kentucky parents say their child weighs too much, but the National Survey of Children's Health found that 37 percent of Kentucky children are overweight or obese. Conversely, 76 percent of parents in the poll think their child's weight is about right, but the national survey found that only 58 percent of Kentucky kids have healthy weight.

The Kentucky Parent survey, taken by land-line and cell telephone from July 19 to Aug. 22 by the Center for Survey Research at the University of Virginia, interviewed 1,006 Kentucky parents, step-parents, grandparents, foster parents or other legal guardians of children in Kentucky selected at random. The statistical margin of error for that sample size is plus or minus 3 percentage points.

The poll also found that 56 percent of Kentucky children are watching more than the maximum daily recommended amount of “screen time” – watching television, playing video games or using the Internet – and that 59 percent drink sugar-sweetened beverages every day. Both are major factors in childhood obesity, research has found, and experts recommend no more than two hours of screen time a day and no sugar-sweetened drinks at all.

“Parents can help reduce this risk by encouraging healthy behaviors for their children,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky.“Our children’s habits and behaviors impact their health today and shape their quality of life as they grow. When kids eat poorly and don’t get enough physical activity, it increases their risk for obesity, diabetes, heart disease and other chronic diseases. This poll data helps us understand what parents think about the behaviors that are so critical to health.”

The Kentucky Parent Survey also found that only 56 percent of Kentucky parents said their child got "enough" fruits and vegetables every day during the preceding week, and 66 percent of parents reported their child got "enough" physical activity every day during the preceding week. It also found that elementary and high-school students often get less than the recommended amount of sleep per day (chart).

The survey did not define "enough." The foundation noted that one strategy to reduce childhood obesity in Kentucky is "5-2-1-0," reflecting experts' recommendations that each day, children should eat at least five servings of fruits and vegetables, have no more than two hours of screen time, engage in one hour of physical activity, and drink zero sugar-sweetened beverages. For the foundation's press release, click here.

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Health coalition asks Nickelodeon to stop marketing sugary and fatty snacks to children

A coalition of health groups thinks maybe it's time to enlist SpongeBob in the childhood obesity fight. Earlier this week, the groups asked the Nickelodeon Channel to stop airing commercials that promote unhealthy foods with the help of the doofy adorable sponge, among other lovable characters the children's channel employs. The letter the groups signed asked that Nickelodeon's parent company, Viacom, put in place strong nutrition standards for the foods marketed by it and by its characters. Their sentiment was strongly backed by the American Academy of Pediatrics.

Elise Viebeck of The Hill's Healthwatch blog quotes the letter: "Research shows that food marketing is an important factor contributing to children's poor diets and obesity. The majority of foods marketed to children remain of poor nutritional quality. The [federal Institute of Medicine] concluded that marketing puts children's health at risk." The letter went on to shake its finger at Nickelodeon for being behind Disney and other prominent child marketers on this front. (Read more)

This comes on the same day that the University of Missouri-Kansas City and the University of Kansas Medical Center release study results that found obese children may be more susceptible to food advertising than healthy-weight children, suggesting at least one reason the nation's childhood obesity rate could continue to climb as feared. (Read more)

A coalition of health groups thinks maybe it's time to enlist SpongeBob in the childhood obesity fight. Earlier this week, the groups asked the Nickelodeon Channel to stop airing commercials that promote unhealthy foods with the help of the doofy adorable sponge, among other lovable characters the children's channel employs. The letter the groups signed asked that Nickelodeon's parent company, Viacom, put in place strong nutrition standards for the foods marketed by it and by its characters. Their sentiment was strongly backed by the American Academy of Pediatrics.

Elise Viebeck of The Hill's Healthwatch blog quotes the letter: "Research shows that food marketing is an important factor contributing to children's poor diets and obesity. The majority of foods marketed to children remain of poor nutritional quality. The [federal Institute of Medicine] concluded that marketing puts children's health at risk." The letter went on to shake its finger at Nickelodeon for being behind Disney and other prominent child marketers on this front. (Read more)

This comes on the same day that the University of Missouri-Kansas City and the University of Kansas Medical Center release study results that found obese children may be more susceptible to food advertising than healthy-weight children, suggesting at least one reason the nation's childhood obesity rate could continue to climb as feared. (Read more)

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Kentucky parents' overall perception of Kentucky children's health doesn't match the statistics, foundation survey finds

Many Kentucky parents' perception of their children's health doesn't match statistics, suggesting that many health problems are going undetected or untreated.

That is the upshot of the Foundation for a Healthy Kentucky's first Kentucky Parent Survey, conducted by the University of Virginia's Center for Survey Research this summer and released today.

Only 4 percent of Kentucky parents said a health professional had told them their child was obese, but the National Survey of Children's Health in 2007 found that almost 37 percent of Kentucky children were obese.

Just 5 percent of Kentucky parents said they had been told that their child had depression or anxiety, but about 25 percent of children 13 to 18 will have struggled with anxiety and 11 percent will have battled depression, according to a 2010 national study. And a recent study found that Kentucky teens were more likely than the national average to have attempted suicide.

About 17 percent of Kentucky parents reported that their child had decayed teeth or cavities, but a national survey of third graders in 2001-02 revealed that 35 percent had untreated dental issues.

Only 3 percent of parents said their child was diagnosed with a hearing problem, but 15 percent of children nationally have measurable hearing loss. And 14 percent reported being told their child had a vision problem, but about one in four preschoolers nationally have vision issues.

Parents also seem not to get enough advice from health care providers about how to treat their children's health issues, even though there are high rates of children suffering from tooth decay, vision problems, asthma, ADHD, depression/anxiety, obesity, hearing impairment and diabetes, the survey found.

While 92 percent of parents said their child had a regular doctor, just 80 percent said their child had a regular dental care provider. And a 74 percent majority of parents surveyed said they were always encouraged by their child's healthcare provider to ask questions during visits. "The exceptions are worth noting," said Susan Zepeda, president and CEO of the foundation. "If three in four parents said their child's provider always encouraged questions, this means that one in four were not always encouraged to ask questions." (Read more)

Many Kentucky parents' perception of their children's health doesn't match statistics, suggesting that many health problems are going undetected or untreated.

That is the upshot of the Foundation for a Healthy Kentucky's first Kentucky Parent Survey, conducted by the University of Virginia's Center for Survey Research this summer and released today.

Only 4 percent of Kentucky parents said a health professional had told them their child was obese, but the National Survey of Children's Health in 2007 found that almost 37 percent of Kentucky children were obese.

Just 5 percent of Kentucky parents said they had been told that their child had depression or anxiety, but about 25 percent of children 13 to 18 will have struggled with anxiety and 11 percent will have battled depression, according to a 2010 national study. And a recent study found that Kentucky teens were more likely than the national average to have attempted suicide.

About 17 percent of Kentucky parents reported that their child had decayed teeth or cavities, but a national survey of third graders in 2001-02 revealed that 35 percent had untreated dental issues.

Only 3 percent of parents said their child was diagnosed with a hearing problem, but 15 percent of children nationally have measurable hearing loss. And 14 percent reported being told their child had a vision problem, but about one in four preschoolers nationally have vision issues.

Parents also seem not to get enough advice from health care providers about how to treat their children's health issues, even though there are high rates of children suffering from tooth decay, vision problems, asthma, ADHD, depression/anxiety, obesity, hearing impairment and diabetes, the survey found.

While 92 percent of parents said their child had a regular doctor, just 80 percent said their child had a regular dental care provider. And a 74 percent majority of parents surveyed said they were always encouraged by their child's healthcare provider to ask questions during visits. "The exceptions are worth noting," said Susan Zepeda, president and CEO of the foundation. "If three in four parents said their child's provider always encouraged questions, this means that one in four were not always encouraged to ask questions." (Read more)

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Canadian study suggests children in day care are more likely to be obese than those cared for by their parents

Children who attend day care regularly are 50 percent more likely to be overweight than those who stay home with parents, according to a new University of Montreal study in Quebec. Lead researcher Marie-Claude Geoffroy said the disparity "cannot be explained by known risk factors such as socioeconomic status of the parents, breastfeeding, body mass index of the mother, or employment status of the mother."

Researchers studied more than 1,600 families with children born in 1997 and 1998 in Quebec, a sample that was representative of the majority of kids in the province. Mothers were interviewed about their children's care at ages 1.5, 2.5, 3.5 and 4. Children were put into groups based on the type of care they received most. Researchers concluded that 65 percent of children spent most of their time in day care. Just 19 percent were cared for mostly by a parent.

Researchers found no clear explanation for the weight disparities, but they argued that day care has the potential to reduce weight problems in children through promotion of physical activity and healthy eating. (Read more)

Children who attend day care regularly are 50 percent more likely to be overweight than those who stay home with parents, according to a new University of Montreal study in Quebec. Lead researcher Marie-Claude Geoffroy said the disparity "cannot be explained by known risk factors such as socioeconomic status of the parents, breastfeeding, body mass index of the mother, or employment status of the mother."

Researchers studied more than 1,600 families with children born in 1997 and 1998 in Quebec, a sample that was representative of the majority of kids in the province. Mothers were interviewed about their children's care at ages 1.5, 2.5, 3.5 and 4. Children were put into groups based on the type of care they received most. Researchers concluded that 65 percent of children spent most of their time in day care. Just 19 percent were cared for mostly by a parent.

Researchers found no clear explanation for the weight disparities, but they argued that day care has the potential to reduce weight problems in children through promotion of physical activity and healthy eating. (Read more)

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No-Hit zones in place in pediatric wards of Kosair and U of L children's hospitals

Health professionals and other employees at Kosair Children's Hospital and the University of Louisville pediatrics unit were given an unusual tool this week when it was announced that their facilities are now No-Hit Zones. A program developed to maintain a calm, safe and caring environment for children and their parents, the No-Hit Zone initiative works to educate staffers on how to keep everyone on the ward safe from those who would lose their tempers while everyone around them is already in a stressful situation.

The policy is quite clear. No adult shall hit another adult. No adult shall hit a child. No child can hit an adult. And no child can hit another child while in the hospital environment.

The Kosair Children's, Kosair Children's-Brownsboro and U of L hospitals are now among only 30 children’s hospitals nationwide to implement the No-Hit Zone program. The Louisville effort has been led by Erin Frazier, M.D., FAAP, associate professor of pediatrics at the Uof L Children & Youth Project, and the Kosair Children’s Hospital Child Abuse Task Force, which Dr. Frazier chairs.

To learn about the No-Hit Zone, go here.

Health professionals and other employees at Kosair Children's Hospital and the University of Louisville pediatrics unit were given an unusual tool this week when it was announced that their facilities are now No-Hit Zones. A program developed to maintain a calm, safe and caring environment for children and their parents, the No-Hit Zone initiative works to educate staffers on how to keep everyone on the ward safe from those who would lose their tempers while everyone around them is already in a stressful situation.

The policy is quite clear. No adult shall hit another adult. No adult shall hit a child. No child can hit an adult. And no child can hit another child while in the hospital environment.

The Kosair Children's, Kosair Children's-Brownsboro and U of L hospitals are now among only 30 children’s hospitals nationwide to implement the No-Hit Zone program. The Louisville effort has been led by Erin Frazier, M.D., FAAP, associate professor of pediatrics at the Uof L Children & Youth Project, and the Kosair Children’s Hospital Child Abuse Task Force, which Dr. Frazier chairs.

To learn about the No-Hit Zone, go here.

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Electric cooperatives' monthly magazine looks at the poor health of our state's children

Courtney Cagle, 14, of Clinton learns
how to cook healthy spaghetti in UK's
Cooperative Extension nutrition program

The November issue of Kentucky Living magazine, published monthly for member-customers of the state's electric cooperatives, focuses on children's health. Editor Paul Wesslund writes that the stories and statistics on the current state of the state's kids are "scary."

Reporter James Nold Jr. writes that when experts were asked about their concerns for the state, childhood obesity was front and center. The state ties Georgia and Arkansas for the second highest share of children (37 percent) who are obese, and it trails only Mississippi among children 10 to 17. That’s more than one in three kids who are grossly unfit.

Also of concern are Kentucky children's high rates of asthma, abuse, neglect, and cigarette smoking. The numbers for these are so bad and so seemingly out of control now that health professionals would be happy just to see them remain stable in the future, instead of continuously rising.

Nold writes that the experts' urgency on these matters was palpable. A lot of them talked about the way poor nutrition can harm children now and throughout the rest of their lives.  They also expressed deep concern for the lack of dental education and care, the need for more exercise and for more parent involvement in all of their children's choices.

The magazine, which has a Health Club for children, notes that the University of Kentucky's Cooperative Extension Service provides nutrition education to students in all 120 counties. For more information on the club, or to join, go to www.KentuckyLiving.com and click on "KL Health Club." (Read more)

Courtney Cagle, 14, of Clinton learns
how to cook healthy spaghetti in UK's
Cooperative Extension nutrition program

The November issue of Kentucky Living magazine, published monthly for member-customers of the state's electric cooperatives, focuses on children's health. Editor Paul Wesslund writes that the stories and statistics on the current state of the state's kids are "scary."

Reporter James Nold Jr. writes that when experts were asked about their concerns for the state, childhood obesity was front and center. The state ties Georgia and Arkansas for the second highest share of children (37 percent) who are obese, and it trails only Mississippi among children 10 to 17. That’s more than one in three kids who are grossly unfit.

Also of concern are Kentucky children's high rates of asthma, abuse, neglect, and cigarette smoking. The numbers for these are so bad and so seemingly out of control now that health professionals would be happy just to see them remain stable in the future, instead of continuously rising.

Nold writes that the experts' urgency on these matters was palpable. A lot of them talked about the way poor nutrition can harm children now and throughout the rest of their lives.  They also expressed deep concern for the lack of dental education and care, the need for more exercise and for more parent involvement in all of their children's choices.

The magazine, which has a Health Club for children, notes that the University of Kentucky's Cooperative Extension Service provides nutrition education to students in all 120 counties. For more information on the club, or to join, go to www.KentuckyLiving.com and click on "KL Health Club." (Read more)

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More bad news about childhood obesity: Study finds it can change some kids' brains and damage their mental 'flexibility'

It's not news that Kentucky is lagging in child fitness. In fact, the Truth for America's Health "F as in Fat" report found that the state has the third highest childhood obesity rate in the country. This is bad news, alright, and it's about to get worse. Dr. Claire McCarthy writes in The Boston Globe that a new study in the current issue of Pediatrics and shows that obesity can hurt kids' brains.

"Researchers looked at 49 adolescents with metabolic syndrome. Metabolic syndrome, a consequence of obesity, is the triad of insulin resistance (pre-diabetes or diabetes), high blood pressure and high blood lipids," McCarthy writes. "The researchers compared the adolescents with 62 adolescents who had the same socioeconomic background but didn't have metabolic syndrome. The kids with metabolic syndrome had more trouble with arithmetic, spelling, attention and mental 'flexibility' than the ones who didn't have metabolic syndrome. Even more frightening, the researchers saw actual changes in their brains, in the hippocampus (which plays a crucial role in memory) and the white matter (which passes messages through the brain). It was only a small study, and not all kids with obesity have metabolic syndrome. But this study is alarming -- especially since we don't know if losing weight can make the brain go back to normal."

In her column tagged "MD Mama," McCarthy goes on: "Given that brains are still developing in adolescence, it's very possible that the changes could be permanent. What else do we need before we take the problem of childhood obesity really seriously?" (Read more) To read the study in Pedatrics, go here.

It's not news that Kentucky is lagging in child fitness. In fact, the Truth for America's Health "F as in Fat" report found that the state has the third highest childhood obesity rate in the country. This is bad news, alright, and it's about to get worse. Dr. Claire McCarthy writes in The Boston Globe that a new study in the current issue of Pediatrics and shows that obesity can hurt kids' brains.

"Researchers looked at 49 adolescents with metabolic syndrome. Metabolic syndrome, a consequence of obesity, is the triad of insulin resistance (pre-diabetes or diabetes), high blood pressure and high blood lipids," McCarthy writes. "The researchers compared the adolescents with 62 adolescents who had the same socioeconomic background but didn't have metabolic syndrome. The kids with metabolic syndrome had more trouble with arithmetic, spelling, attention and mental 'flexibility' than the ones who didn't have metabolic syndrome. Even more frightening, the researchers saw actual changes in their brains, in the hippocampus (which plays a crucial role in memory) and the white matter (which passes messages through the brain). It was only a small study, and not all kids with obesity have metabolic syndrome. But this study is alarming -- especially since we don't know if losing weight can make the brain go back to normal."

In her column tagged "MD Mama," McCarthy goes on: "Given that brains are still developing in adolescence, it's very possible that the changes could be permanent. What else do we need before we take the problem of childhood obesity really seriously?" (Read more) To read the study in Pedatrics, go here.

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Kentucky ranks third among the states in child obesity, a problem that has a broad scope and deep roots (first in a series)

(Photo by Tara Kaprowy for Kentucky Health News)

By Tara Kaprowy
Kentucky Health News

At every Girl Scouts meeting, Christmas concert, soccer field and swimming pool in Kentucky lies a trend that is easy to spot. It doesn't have to do with the Toms on the children's feet or the feathers affixed to their hair. It's the fact that every third child in Kentucky is overweight, and many of them are obese. As they stand in front of the crowd or struggle to swim to the other side, the problem is plain. Its consequences are not so plan, but are far-reaching.

Kentucky has the third-highest childhood obesity rate in the country and the seventh-highest rate in adult obesity, Trust for America's Health's "F as in Fat" report shows. Sixty percent of Kentucky women and 80 percent of men living the state are either overweight or obese.

CHILD OBESITY RATES from Trust for America's Health

Estimates show that one in three children who were born in the year 2000

will develop Type II diabetes at one point in their lives, in large part because of the food choices they make. "We're also seeing lots of heart indicators, like high-blood pressure, high lipids and cardiac changes, in kids that are overweight," said Dr. Christopher Bolling, a pediatrician in Kenton County. "And we're seeing a lot of other issues like liver disease and kids with orthopedic problems."

Obese children can also have breathing problems like sleep apnea and asthma. They struggle with low self-esteem and the depression that can result from it. And they are the first American generation expected to live a shorter life than their parents. "They're taking medicine we used to give to old people," said Duff Holcomb, the schools nurse in Laurel County. "They're 15 and 16, so what are they going to be like when they're 36?"

The issue stems from "a perfect storm" of factors, said Elaine Russell, the state's obesity prevention coordinator. "Our food is high in calories with little nutrients," she said. "A lot of physical education has been taken out of normal daily routines."

And food is everywhere, from billboards to unexpected places like cash registers at T.J. Maxx and Office Depot, Russell said. One study found kids see about 4,000 television commercials advertising food each year. During Saturday morning cartoons, they see a food ad nearly every five minutes, and about 95 percent are pushing food with poor nutritional value. "And it's not just TV," Russell said. "Look at all the billboards, look at the Internet, look at your packaging, with characters that say, 'Come see me and do the Web game.'"

The variety of food is also staggering, Russell pointed out. "Look and see how many Oreos there are. It's not just Oreo or double-stuffed. There's also ones with mint and peanut butter. How many different chips? How many different sodas? Our choices are so unlimited."

Halloween candy displays are already set up
in grocery stores, pharmacies and other stores
across the state. (Photo by Tara Kaprowy)

So, it's easy for children to make the wrong choices. Almost 40 percent of the total calories consumed by 2- to 18-year-olds are in the form of empty calories, meaning solid fat and added sugars. Next to Mississippi, Kentucky youth drink the most soft drinks in the country — up to 89 gallons per person, according to information researchers at the University of Kentucky's Nutrition Education Program compiled from the USDA's Food Environment Atlas. Meanwhile, just 17 percent of Kentucky high school students reported eating fruit and vegetables five times per day over a week's time, the amount recommended by the United States Department of Agriculture.

Children adopt bad eating habits from their parents, who "gatekeepers" of the kitchen, Russell said. "If Mom and Dad are feeding you [junk food] then you tend to eat that because that's what available to you."

Parents blame busy schedules and lack of time — and they are busier, in large part because both parents work in most households. Also, many of today's parents either don't like to cook, or can't.

Debra Cotterill teaches cooking classes for the University of Kentucky's Nutrition Education Program and is often shocked at the decline in cooking skills. "There's people out there who have said to me that they literally did not know how to boil water," she said. "I've also met people who live on candy and packaged chips because they don't know how to cook." Ginger Gray, director of food services in Kenton County Schools, was not surprised, saying many of today's parents "are a generation of microwave users."

Exacerbating the problem is a lack of exercise. Gone are the days of students heading to the change room to get ready for gym class. In Kentucky, elementary schools must offer some type of physical activity for 30 minutes each day, but that can include unsupervised recess. There are no physical education requirements in middle schools, and high-school students just need to take one half-credit of phys-ed to graduate. The decline in phys-ed is coupled with the fact that kids lead an increasingly sedentary lifestyle. In Kentucky, nearly one in three high school students watch three or more hours of TV each day and more than 60 percent of kids have a TV in their bedroom.

A lack of play time after school is another culprit, in large part because "There's a lot of media that say it's not safe to go outside and play," Russell said. In fact, just over 100 children are kidnapped in a stereotypical way each year in the U.S., according to the National Center for Missing & Exploited Children, and the number of violent crimes was lower last year than it has been in 40 years. Yet, fear of the unknown is embedded in parents, Gray said, who sees parents waiting in their running cars for their children to be dropped off at bus stops. "What a huge impact changing that attitude would make," she said.

(Photo by Tara Kaprowy, Kentucky Health News)

While the report "Shaping Kentucky's Future: A Community Guide to Reducing Obesity" estimates 33 percent of Kentucky children are already overweight or obese, there is no way of knowing how those numbers vary county to county, because there is no systematic collection of them. Body-mass index, a rough measure of fat to weight, is measured statewide only for children aged 2 to 4 in the Women, Infants and Children nutrition program. "Some individual school districts and counties are collecting more information, but it is spotty," said Sarah Walsh, senior program officer at the Foundation for a Healthy Kentucky.

Starting this school year, the state board of education started requiring that there be a place on the state health exam form that includes a student's BMI, though physicians are not required to fill it in. The exams are required when a student enters school in Kentucky, generally in kindergarten, and again when a student is about to enter the sixth grade. "I would say it's a start but this is not a mandate on students or parents or physicians or schools. This is an option," said Lisa Gross, spokeswoman for the Kentucky Department of Education. Still, the BMI information could be shared at the aggregate level if the Department of Public Health asked for it as part of an analysis, Gross said.

But regardless of what data is collected, there is a problem "showing us basically whatever age group you look at, you've got too high of a proportion of children who are overweight and obese," said Amy Swann, senior policy analyst for Kentucky Youth Advocates. Some data show obesity rates are higher in children living in the Appalachian part of the state. Many studies also correlate children from low-income families with higher obesity rates. Giving counties an idea of where they stand is essential to getting a handle on the fight. "There is an old adage that 'what gets measured gets done,' and it couldn't be more true in this case," said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky. "Local communities need to know where they stand on this important health issue so they can track progress and really make changes with childhood obesity."

NEXT: What is being done in nationwide, in Kentucky, and in individual communities to address the problem.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

(Photo by Tara Kaprowy for Kentucky Health News)

By Tara Kaprowy
Kentucky Health News

At every Girl Scouts meeting, Christmas concert, soccer field and swimming pool in Kentucky lies a trend that is easy to spot. It doesn't have to do with the Toms on the children's feet or the feathers affixed to their hair. It's the fact that every third child in Kentucky is overweight, and many of them are obese. As they stand in front of the crowd or struggle to swim to the other side, the problem is plain. Its consequences are not so plan, but are far-reaching.

Kentucky has the third-highest childhood obesity rate in the country and the seventh-highest rate in adult obesity, Trust for America's Health's "F as in Fat" report shows. Sixty percent of Kentucky women and 80 percent of men living the state are either overweight or obese.

CHILD OBESITY RATES from Trust for America's Health

Estimates show that one in three children who were born in the year 2000

will develop Type II diabetes at one point in their lives, in large part because of the food choices they make. "We're also seeing lots of heart indicators, like high-blood pressure, high lipids and cardiac changes, in kids that are overweight," said Dr. Christopher Bolling, a pediatrician in Kenton County. "And we're seeing a lot of other issues like liver disease and kids with orthopedic problems."

Obese children can also have breathing problems like sleep apnea and asthma. They struggle with low self-esteem and the depression that can result from it. And they are the first American generation expected to live a shorter life than their parents. "They're taking medicine we used to give to old people," said Duff Holcomb, the schools nurse in Laurel County. "They're 15 and 16, so what are they going to be like when they're 36?"

The issue stems from "a perfect storm" of factors, said Elaine Russell, the state's obesity prevention coordinator. "Our food is high in calories with little nutrients," she said. "A lot of physical education has been taken out of normal daily routines."

And food is everywhere, from billboards to unexpected places like cash registers at T.J. Maxx and Office Depot, Russell said. One study found kids see about 4,000 television commercials advertising food each year. During Saturday morning cartoons, they see a food ad nearly every five minutes, and about 95 percent are pushing food with poor nutritional value. "And it's not just TV," Russell said. "Look at all the billboards, look at the Internet, look at your packaging, with characters that say, 'Come see me and do the Web game.'"

The variety of food is also staggering, Russell pointed out. "Look and see how many Oreos there are. It's not just Oreo or double-stuffed. There's also ones with mint and peanut butter. How many different chips? How many different sodas? Our choices are so unlimited."

Halloween candy displays are already set up
in grocery stores, pharmacies and other stores
across the state. (Photo by Tara Kaprowy)

So, it's easy for children to make the wrong choices. Almost 40 percent of the total calories consumed by 2- to 18-year-olds are in the form of empty calories, meaning solid fat and added sugars. Next to Mississippi, Kentucky youth drink the most soft drinks in the country — up to 89 gallons per person, according to information researchers at the University of Kentucky's Nutrition Education Program compiled from the USDA's Food Environment Atlas. Meanwhile, just 17 percent of Kentucky high school students reported eating fruit and vegetables five times per day over a week's time, the amount recommended by the United States Department of Agriculture.

Children adopt bad eating habits from their parents, who "gatekeepers" of the kitchen, Russell said. "If Mom and Dad are feeding you [junk food] then you tend to eat that because that's what available to you."

Parents blame busy schedules and lack of time — and they are busier, in large part because both parents work in most households. Also, many of today's parents either don't like to cook, or can't.

Debra Cotterill teaches cooking classes for the University of Kentucky's Nutrition Education Program and is often shocked at the decline in cooking skills. "There's people out there who have said to me that they literally did not know how to boil water," she said. "I've also met people who live on candy and packaged chips because they don't know how to cook." Ginger Gray, director of food services in Kenton County Schools, was not surprised, saying many of today's parents "are a generation of microwave users."

Exacerbating the problem is a lack of exercise. Gone are the days of students heading to the change room to get ready for gym class. In Kentucky, elementary schools must offer some type of physical activity for 30 minutes each day, but that can include unsupervised recess. There are no physical education requirements in middle schools, and high-school students just need to take one half-credit of phys-ed to graduate. The decline in phys-ed is coupled with the fact that kids lead an increasingly sedentary lifestyle. In Kentucky, nearly one in three high school students watch three or more hours of TV each day and more than 60 percent of kids have a TV in their bedroom.

A lack of play time after school is another culprit, in large part because "There's a lot of media that say it's not safe to go outside and play," Russell said. In fact, just over 100 children are kidnapped in a stereotypical way each year in the U.S., according to the National Center for Missing & Exploited Children, and the number of violent crimes was lower last year than it has been in 40 years. Yet, fear of the unknown is embedded in parents, Gray said, who sees parents waiting in their running cars for their children to be dropped off at bus stops. "What a huge impact changing that attitude would make," she said.

(Photo by Tara Kaprowy, Kentucky Health News)

While the report "Shaping Kentucky's Future: A Community Guide to Reducing Obesity" estimates 33 percent of Kentucky children are already overweight or obese, there is no way of knowing how those numbers vary county to county, because there is no systematic collection of them. Body-mass index, a rough measure of fat to weight, is measured statewide only for children aged 2 to 4 in the Women, Infants and Children nutrition program. "Some individual school districts and counties are collecting more information, but it is spotty," said Sarah Walsh, senior program officer at the Foundation for a Healthy Kentucky.

Starting this school year, the state board of education started requiring that there be a place on the state health exam form that includes a student's BMI, though physicians are not required to fill it in. The exams are required when a student enters school in Kentucky, generally in kindergarten, and again when a student is about to enter the sixth grade. "I would say it's a start but this is not a mandate on students or parents or physicians or schools. This is an option," said Lisa Gross, spokeswoman for the Kentucky Department of Education. Still, the BMI information could be shared at the aggregate level if the Department of Public Health asked for it as part of an analysis, Gross said.

But regardless of what data is collected, there is a problem "showing us basically whatever age group you look at, you've got too high of a proportion of children who are overweight and obese," said Amy Swann, senior policy analyst for Kentucky Youth Advocates. Some data show obesity rates are higher in children living in the Appalachian part of the state. Many studies also correlate children from low-income families with higher obesity rates. Giving counties an idea of where they stand is essential to getting a handle on the fight. "There is an old adage that 'what gets measured gets done,' and it couldn't be more true in this case," said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky. "Local communities need to know where they stand on this important health issue so they can track progress and really make changes with childhood obesity."

NEXT: What is being done in nationwide, in Kentucky, and in individual communities to address the problem.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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Child obesity is a complex problem, intimidating to those who are fighting it (last in a series)

Dr. Christopher Bolling prepares to see a patient.

By Tara Kaprowy
Kentucky Health News

Nearly every weekday, pediatrician Christopher Bolling starts his day by scooping up his lap top and stepping into one of his cheerfully-appointed exam rooms. After greeting his young patients, who are generally passing the time by playing games on their parents' cell phones, Bolling begins his examinations. During his 21 years of practice, those exams have increasingly ended with Bolling counseling parents about their children's weight.

"I tell them I'm not worried about this as a cosmetic issue, I'm worried about this as a health issue," he said in an interview. "This isn't about your child being ugly or undesirable, we talk about them being healthy and not healthy."

But, though dedicated to his cause, Bolling, of Crestview Hills in Kenton County, said he is keenly aware that his counseling is not nearly enough to help his patients overcome the weight that is impeding their health. "What makes this problem unique is it is so multifactorial, there are so many pieces to it," he said. "It's food, it's activity, it's portion size, it's fruit and vegetables, it's screen time and safety. And it makes it really intimidating to know what to do with it."

"We're swimming upstream in a flooded river," agreed Debra Cotterill, director of the Nutrition Education Program at the University of Kentucky. "Even for people who know it, it's still hard. Weight is an issue I have to address every single day of my life and I understand how it is for people. You're talking about change of behaviors."

It's like smoking, but it's different

But a sweeping change in behavior is going to be what it takes to turn the tide of the obesity epidemic, experts say, and that is one reason fighting obesity is often likened to the battle against smoking. The fact that it is just as, if not more, deadly is another parallel, as is the fact that it is just as, if not more, far-reaching.

But there are key differences in battling the two problems, Judith Graham noted in a story for Kaiser Health News. First, other than an increase in health-care costs, there is no compelling argument that implies that another person's weight adversely affects others, like second-hand smoking does for smoking, or drunk driving does for drinking to excess. "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," Michael Ericksen, director of the Institute of Public Health at Georgia State University, told Graham.

Compounding the issue is there is nearly no end to the variety of food that can contribute to the problem. Unlike Big Tobacco, the food industry also cannot be demonized as easily, Graham points out. But most importantly, "unlike alcohol and tobacco, you can't go cold turkey on food," Bolling said. "You have to keep eating."

But if there is consensus on how to approach the issue, it is to take a lesson from the battle against smoking, which is to focus on changing the environment that encourages bad habits. "It's about changing our culture," explained Elaine Russell, Kentucky's obesity prevention coordinator. "We need an environment where the healthy choice is the easy choice."

That involves policy change, setting up systems that support the policy changes, and environmental change, Russell said, all of which have to happen together. "There's no one solution that's going to do it," she said. "If we embed it in our policies, but we don't embed it into our environment, how do we make the healthier choice? If we just educate people but we don't provide them with a healthy environment, then how do they make those healthy choices? We could do an educational campaign at our worksite, but if we have unhealthy vending machines there, how can you make the changes?"

Local action is needed

Russell said change needs to happen at the local level, since every community has different needs and "starts with high-level partners really being engaged," she said. "We need to pull together those leaders and ask them what the highest priority is, ask them what feasibly can be done and start checking them off."

Some of those changes can be as easy as placing bananas and apples at the front of the pool concession stand so children see them first, as they did in Lexington. The same is being done in school cafeteria lines. But others cost money that communities don't necessarily have, as the Healthy Children's Task Force learned in Laurel County when trying to assess students' body-mass index, a rough measure of fat to weight.

In 2005, the task force started collecting BMIs of a select group of children in kindergarten to see where the county stood. It found 37 percent were either overweight or obese, and quickly decided the goal should be to bring that number down to 31 percent, the statewide average at the time. Using a grant from the parent company of the local hospital, they talked to parents, hired gym teachers, had schools incorporate 10 minutes of physical activity in the classroom periodically during the day, talked to kids about nutrition, and got them to cook and sample fruit and vegetables from a mobile demonstration kitchen.

The overweight rates of the children, who were repeatedly assessed each year, did decrease by the targeted 6 percent, but when funding ran out, the program faltered. For a few years, part of the effort was restored, but the task force has disbanded. "You get real gung-ho on it and something else comes along," said school nurse Duff Holcomb, who led the effort. "It makes me feel terribly guilty, but that is just the way it is. We proved what works."

After a recent analysis showed 12 states, including Kentucky, have adult obesity levels over 30 percent, Jeffrey Levi, executive director of Trust for America's Health, acknowledged the financial problem: "We're not investing anywhere near what we need to in order to bend the obesity curve and see the returns in health and savings."

(Photos by Tara Kaprowy)

More regulation is one option, a move that is generally cheap in cost but can be politically expensive. New York City Mayor Michael Bloomberg is learning that, after proposing a ban in New York City on the sale of supersize sodas and other sugary drinks by restaurants, movie theaters and street carts. Residents are deeply divided on the issue — 60 percent oppose the ban — and critics have lambasted Bloomberg, accusing him of running a "nanny state."

But limiting food and drink choices may have an effect on people's health, a recent study indicates. The removal of trans fats from many processed and fast foods like French fries and cookies probably reduced the proportion of kids with high cholesterol in the past decade, researchers think.

More regulation, particularly in how food is marketed to children, is what Josh Golin, associate director for the Campaign for Commercial-Free Childhood, would like to see. "We can't rely on the companies to self-regulate or develop their own policies," he said. "We see a lot of self-serving regulations that vary from company to company. What we really need is to level the playing field and make the rules enforceable."

In addition, Bolling suggested "there are several organizations that advocate that we could make a big impact on childhood obesity by placing an excise tax on sodas." A report by the Rudd Center for Food Policy and Obesity at Yale University indicated that a 10 percent tax on soft drinks would result in about an 8 percent reduction in consumption. Studies on alcohol and tobacco taxes indicate similar findings. A Rudd Center calculator shows a 1-cent tax on each ounce of sugar-sweetened beverages sold in Kentucky could result in nearly $200 million in revenue for the state.

Whether regulation or investing more money in the problem are part of the solution, Bolling said solving the problem will take time and a variety of efforts. "We have to solve everything together," he said. "It's about personal responsibility, but it's also about supportive families, it's about primary care medical people knowing what to say to their patients, it's about workplaces and schools creating good environments and it's communities providing opportunities to be healthy. I think we're going to turn the tide. We've done it before with seat belts, with bicycle helmets, with smoking. While this problem is complicated, we already see people really waking up to it."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Dr. Christopher Bolling prepares to see a patient.

By Tara Kaprowy
Kentucky Health News

Nearly every weekday, pediatrician Christopher Bolling starts his day by scooping up his lap top and stepping into one of his cheerfully-appointed exam rooms. After greeting his young patients, who are generally passing the time by playing games on their parents' cell phones, Bolling begins his examinations. During his 21 years of practice, those exams have increasingly ended with Bolling counseling parents about their children's weight.

"I tell them I'm not worried about this as a cosmetic issue, I'm worried about this as a health issue," he said in an interview. "This isn't about your child being ugly or undesirable, we talk about them being healthy and not healthy."

But, though dedicated to his cause, Bolling, of Crestview Hills in Kenton County, said he is keenly aware that his counseling is not nearly enough to help his patients overcome the weight that is impeding their health. "What makes this problem unique is it is so multifactorial, there are so many pieces to it," he said. "It's food, it's activity, it's portion size, it's fruit and vegetables, it's screen time and safety. And it makes it really intimidating to know what to do with it."

"We're swimming upstream in a flooded river," agreed Debra Cotterill, director of the Nutrition Education Program at the University of Kentucky. "Even for people who know it, it's still hard. Weight is an issue I have to address every single day of my life and I understand how it is for people. You're talking about change of behaviors."

It's like smoking, but it's different

But a sweeping change in behavior is going to be what it takes to turn the tide of the obesity epidemic, experts say, and that is one reason fighting obesity is often likened to the battle against smoking. The fact that it is just as, if not more, deadly is another parallel, as is the fact that it is just as, if not more, far-reaching.

But there are key differences in battling the two problems, Judith Graham noted in a story for Kaiser Health News. First, other than an increase in health-care costs, there is no compelling argument that implies that another person's weight adversely affects others, like second-hand smoking does for smoking, or drunk driving does for drinking to excess. "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," Michael Ericksen, director of the Institute of Public Health at Georgia State University, told Graham.

Compounding the issue is there is nearly no end to the variety of food that can contribute to the problem. Unlike Big Tobacco, the food industry also cannot be demonized as easily, Graham points out. But most importantly, "unlike alcohol and tobacco, you can't go cold turkey on food," Bolling said. "You have to keep eating."

But if there is consensus on how to approach the issue, it is to take a lesson from the battle against smoking, which is to focus on changing the environment that encourages bad habits. "It's about changing our culture," explained Elaine Russell, Kentucky's obesity prevention coordinator. "We need an environment where the healthy choice is the easy choice."

That involves policy change, setting up systems that support the policy changes, and environmental change, Russell said, all of which have to happen together. "There's no one solution that's going to do it," she said. "If we embed it in our policies, but we don't embed it into our environment, how do we make the healthier choice? If we just educate people but we don't provide them with a healthy environment, then how do they make those healthy choices? We could do an educational campaign at our worksite, but if we have unhealthy vending machines there, how can you make the changes?"

Local action is needed

Russell said change needs to happen at the local level, since every community has different needs and "starts with high-level partners really being engaged," she said. "We need to pull together those leaders and ask them what the highest priority is, ask them what feasibly can be done and start checking them off."

Some of those changes can be as easy as placing bananas and apples at the front of the pool concession stand so children see them first, as they did in Lexington. The same is being done in school cafeteria lines. But others cost money that communities don't necessarily have, as the Healthy Children's Task Force learned in Laurel County when trying to assess students' body-mass index, a rough measure of fat to weight.

In 2005, the task force started collecting BMIs of a select group of children in kindergarten to see where the county stood. It found 37 percent were either overweight or obese, and quickly decided the goal should be to bring that number down to 31 percent, the statewide average at the time. Using a grant from the parent company of the local hospital, they talked to parents, hired gym teachers, had schools incorporate 10 minutes of physical activity in the classroom periodically during the day, talked to kids about nutrition, and got them to cook and sample fruit and vegetables from a mobile demonstration kitchen.

The overweight rates of the children, who were repeatedly assessed each year, did decrease by the targeted 6 percent, but when funding ran out, the program faltered. For a few years, part of the effort was restored, but the task force has disbanded. "You get real gung-ho on it and something else comes along," said school nurse Duff Holcomb, who led the effort. "It makes me feel terribly guilty, but that is just the way it is. We proved what works."

After a recent analysis showed 12 states, including Kentucky, have adult obesity levels over 30 percent, Jeffrey Levi, executive director of Trust for America's Health, acknowledged the financial problem: "We're not investing anywhere near what we need to in order to bend the obesity curve and see the returns in health and savings."

(Photos by Tara Kaprowy)

More regulation is one option, a move that is generally cheap in cost but can be politically expensive. New York City Mayor Michael Bloomberg is learning that, after proposing a ban in New York City on the sale of supersize sodas and other sugary drinks by restaurants, movie theaters and street carts. Residents are deeply divided on the issue — 60 percent oppose the ban — and critics have lambasted Bloomberg, accusing him of running a "nanny state."

But limiting food and drink choices may have an effect on people's health, a recent study indicates. The removal of trans fats from many processed and fast foods like French fries and cookies probably reduced the proportion of kids with high cholesterol in the past decade, researchers think.

More regulation, particularly in how food is marketed to children, is what Josh Golin, associate director for the Campaign for Commercial-Free Childhood, would like to see. "We can't rely on the companies to self-regulate or develop their own policies," he said. "We see a lot of self-serving regulations that vary from company to company. What we really need is to level the playing field and make the rules enforceable."

In addition, Bolling suggested "there are several organizations that advocate that we could make a big impact on childhood obesity by placing an excise tax on sodas." A report by the Rudd Center for Food Policy and Obesity at Yale University indicated that a 10 percent tax on soft drinks would result in about an 8 percent reduction in consumption. Studies on alcohol and tobacco taxes indicate similar findings. A Rudd Center calculator shows a 1-cent tax on each ounce of sugar-sweetened beverages sold in Kentucky could result in nearly $200 million in revenue for the state.

Whether regulation or investing more money in the problem are part of the solution, Bolling said solving the problem will take time and a variety of efforts. "We have to solve everything together," he said. "It's about personal responsibility, but it's also about supportive families, it's about primary care medical people knowing what to say to their patients, it's about workplaces and schools creating good environments and it's communities providing opportunities to be healthy. I think we're going to turn the tide. We've done it before with seat belts, with bicycle helmets, with smoking. While this problem is complicated, we already see people really waking up to it."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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