Quick hits: Cigarette smoking hits record low; hay rescue for ranchers hit by wildfires; rodeo women return; Yonder Radio

Less than 10% of Americans reported smoking cigarettes
in 2024. (Photo by A. Siimon, Unsplash)

For the first time in recorded U.S. history, the number of Americans who smoke cigarettes has dipped below 10%, reports Sarah Todd for STAT. While the Centers for Disease Control and Prevention collected the data, the U.S. government took the unusual step of releasing it without scientific comment. The lack of a CDC analysis led independent analysts at the digital New England Journal of Medicine Evidence to synthesize the information, which turned out to be good news. "It shows that 9.9% of U.S. adults reported smoking cigarettes in 2024, down from 10.8% in 2023. E-cigarette use remained unchanged from the previous year at 7%."

Wildfires in drought-stricken parts of the U.S. can threaten ranchers' livelihoods by burning through vast swaths of grassland meant to feed a cattle herd, forcing livestock owners to purchase feed or sell livestock. But recently, ranchers have been getting a helping hand from Farm Rescue’s 'Operation Hay Lift,' which steps in and provides free hay, including its delivery, to "help ranchers who lost pasture and feed supplies," reports Jennifer M. Latzke of Kansas Farmer. "With the recent historic wildfires burning more than 701,000 acres across Nebraska, Operation Hay Lift is likely to expand."

Unlike this 1981 couple, some Reese's fans aren't 
as excited about new ingredient mix-ups. 

Once upon a time, when chocolate and peanut butter crashed into each other, it was a happy accident. At least, that's how the 1981 Reese's peanut butter cup ad told the story. But when Reese's food designers create new shapes or design twists, known as "line extensions," not everyone appreciates the new mix-ups. Jonathan Deutsch for The Conversation explains, "Brad Reese, grandson of the founder, issued an open letter criticizing the Hershey Company for introducing line extensions – in this case, mini hearts for Valentine’s Day, with the flavors familiar to Reese’s lovers but made with cheaper ingredients, such as “chocolate candy” and “peanut butter creme.” While Brad Reese and other vocal Reese's fans may not like the ingredient switches, it's a common food industry practice.

The past few years have burdened many American farmers with high costs and low incomes. Farmers' stress can increase with every extreme weather event, fertilizer cost increase or spiking fuel price. It's good to remember that the Farm Aid Hotline (1-800-FARM-AID) is available Monday–Friday to farmers across the U.S. The Farm Aid Hotline connects farmers with resources for stress, legal or financial issues. The AgriStress HelpLine (833-897-2474) is an option for farmers in Arizona, Colorado, Connecticut, Missouri, Montana, Oregon, Pennsylvania, Texas, Virginia, Washington and Wyoming. The free, confidential helpline is open 24/7.

Hali Williams, right, in action. She won RodeoHouston's breakaway 
roping title in 2026. (Photo by Mallory Beinborn, RodeoHouston)

If they'd waited for an invitation or a welcoming wave to take a seat on the horse, they'd still be waiting. "Rodeo said bronco riding wasn’t a sport for women. They got on anyway," reports Haley Potter for Offrange. "Rodeo has tried everything to keep women from it. . . . We were long limited to timed events like barrel racing. . . . Despite a deep history of women in roughstock going back well over a century, modern bronc riding has largely been a man’s game. . . . But all that is changing now."

           

It's new, it's all about rural, and it's served fresh every week. Say hello to Yonder Radio -- an hour-long show designed to cover current events and "feature nuanced stories that represent the 60 million people who live in rural America, and the distinct communities they call home," reports The Daily Yonder. Each topic will add depth to how news and events impact rural lives. Interviewees on the show will highlight arts, music and community projects geared toward rural audiences. Jared Ewy, a veteran radio personality and regular contributor to the Daily Yonder, is Yonder Radio's host. The show is also available as a podcast. If you’re a station interested in broadcasting Yonder Radio, get in contact with the team at info@yonderradio.com 

Quick hits: Bakery sign debate; global cheese demand; Marlboro man's mystique; discover the Stargazer Highway

Local art students created the bakery sign, but a code enforcement 
officer said it had to come down. (Leavitt's Country Bakery reel photo)

Even in closely-knit small towns, not everyone gets along. In Conway, New Hampshire, town officials and Sean Young, a bakery business owner, have been in a legal dust-up since Young installed a front signage mural made by local high school students. "But the town of Conway told Young the painting wasn’t a mural, it was a sign that exceeded the town’s legal size limit and would need to be taken down," reports Kyle Melnick of The Washington Post. "Young left the mural up, and sued the town the following year, claiming its ordinance violates the First Amendment." In May, a judge ruled that Leavitt’s Country Bakery sign, with its giant muffins, donuts and beaming sun, could stay.

The love of cheese products is going global, which is good news for American dairy farmers. "While domestic cheese sales remain soft, global cheese demand is accelerating rapidly," reports Taylor Leach of Daily Herd Management. "Much of that growth is coming from international restaurant menus that are incorporating cheese in new and creative ways. . . . Beyond cheese, other dairy products are gaining traction in international markets as well. Whey proteins and milk proteins, in particular, are seeing increased demand across Asia."

The Marlboro man 'was always adaptable to the times.'
(Philip Morris ad via MEL magazine)

Despite the illness and death cigarette smoking has caused, the Marlboro man remains a strong, stoic, and unequivocally American icon. "The Marlboro man was something of a chameleon, in that he took on multiple meanings and was always adaptable to the times — which, more than anything else, speaks to the durability of the cowboy in American culture," reports Brian VanHooker for MEL magazine. VanHooker shares the storied history of one of the most successful ad campaigns in U.S. history. "Twenty years later, while the Marlboro Man may evoke a sense of nostalgia for some due to its beautiful imagery of the West, for so many who have had a loved one die from smoking-related illnesses, he has a much darker legacy."

Department of Agricultural Secretary Brooke Rollins announced a listing of new Farm Service Agency and Rural Development state directors tasked with implementing the Trump administration's rural agenda. During her announcement, Rollins told reporters, "Our latest additions to the USDA family are personally invested in ensuring farmers and rural America prosper." Mariah Squire of Successful Farming provides a by-state listing of new appointees, with a limited look at their professional backgrounds.

The dark night skies of the Black Canyon in Gunnison National Park, Colorado.
(Photo by G. Owens, National Park Traveler)

America's National Parks offer visual experiences rarely found in other places. A group of photographers wanted to understand more about Native American spiritual history, so they set out across the National Park's path known as the "Stargazer Highway," Eric Jay Toll writes for National Park Traveler. "More than a dozen tribes have traditional lands through which the Stargazer Highway passes, and each has sacred tribal legends explaining the stars in the skies and lessons, consequences, and morals on Earth. . . . These stories [are] along the highway, better known as U.S. 191, and many of its side roads. The road runs 1,545 miles from Mexico to Canada through Arizona, Utah, Wyoming, and Montana, passing 24 national parks, monuments, and tribal parks."

IQOS is marketed as sophisticated and 'safer' than
burned tobacco. (Adobe Stock photo)

Phillip Morris has a slick-looking new tobacco product hitting U.S. markets. "The chicly futuristic branding of IQOS, a heated tobacco product owned by Philip Morris International, is one of several things worrying researchers and anti-tobacco advocates," reports Sarah Todd of STAT. "The company is rolling out pilots of the device. . . peddling IQOS (pronounced “eye-koss”) as the 'next step in tobacco harm reduction.' The company positions the devices as a better alternative for smokers compared to cigarettes." Health advocates don't agree with the company's sales pitch and say that savvy IQOS marketing could convince some people to start an unhealthy, addictive habit. 

Ticks can transmit diseases to humans.
(CDC photo)

The problem with ticks isn't that they look creepy; they spread illnesses with alarming efficiency. Every summer it's good to review the best ways to avoid and if needed, remove hitchhiker ticks. "These vile little creatures transmit Lyme disease, babesiosis, anaplasmosis, Rocky Mountain spotted fever, and ehrlichiosis, among others, and symptoms can range from swollen joints to meat allergies," report Annemarie Conte and Doug Mahoney of Wirecutter. Click here to read "their favorite picks and the advice to keep in mind as you head outdoors this summer."

U.S. Surgeon General outlines ways to address disparities among smokers, including many who are rural Americans

Secondhand smoke harms people who don't smoke.
 (Adobe Stock photo)

Over the past decade, the rate of U.S. adults and teens who smoke has hit its lowest level since 1965, but "disparities remain among the 36 million adults and 760,000 kids who smoke," reports Ken Alltucker of USA Today. U.S. Surgeon General Vivek Murthy released a report that outlined identifiers for those who continue to smoke, which are often the same descriptors used to depict American rural populations: Poorer, less educated, Native American, and lacking access to medical care.

Native Americans, specifically those in Alaska, often live in some of the most remote pockets of the country, where medical access isn't readily available and many residents live in poverty. Alltucker writes, "Smoking is more common among American Indian and Alaska Native people than other racial and ethnic groups. . . . People living in poverty are more than twice as likely to smoke than those who earn non-poverty wages."

Rural populations tend to be heavier smokers than their urban counterparts, and the more rural residents smoke, the unhealthier their broader community becomes. Alltucker explains, "Because cigarette smoking and secondhand smoke kill nearly half a million people each year nationwide, Murthy said an accelerated effort is needed to limit disparities in smoking rates and reduce secondhand smoke."

The report also calls for "limiting the nicotine in cigarettes and other tobacco products to 'minimally addictive or nonaddictive levels,'" Alltucker reports. "Such a move could prevent more than 33 million people from starting to smoke. . ." This change could have a positive effect in rural populations where "kids are also more likely to start smoking at a much younger age and smoke daily, making addiction more severe and smoking harder to quit," the American Lung Association reports.

The Surgeon General's report "cited 2023 research that projected a nationwide ban on the sale and marketing of menthol cigarettes would prevent up to 654,000 deaths in the next four decades," Alltucker reports. But controlling the flow of cigarettes isn't going to happen overnight, and in the meantime, rural access to medical education and smoking cessation programs is needed.

Murthy told USA Today, "What's at stake are the lives of our kids and adults across America. Tobacco is the leading cause of preventable death in the country − 490,000 lives we lose every year to tobacco-related disease. Despite all the progress we've made, that remains the truth today."

Quick hits: Missing factory parts slow supply chains; telehealth could help rural prisoners stop smoking...

Here's a roundup of stories with rural resonance; if you do or see similar work that should be shared on The Rural Blog, email heather.chapman@uky.edu.

One reason for the supply-chain issues plaguing the U.S. (and other countries): factories are having a hard time finding replacement mechanical and computer parts, which slows or halts production. Read more here.

The poultry muscle disease called white striping was nearly nonexistent 10 years ago, but today 99% of U.S. store-brand chickens have it, according to a newly published study from an animal welfare group. Meat from afflicted chickens has up to 224% more fat and 9% more protein than others, but doesn't taste any different. Since the stresses of factory farming cause the ailment, its frequency serves as a rough yardstick for the increasing popularity of such methods. Read more here.

The most common type of liver cancer is on the rise in rural America but trending down in cities, according to newly published research. Hepatocellular carcinoma is the most common type of liver cancer and the fastest-growing cause of cancer deaths in the U.S. Diagnoses are increasing at an annual rate of nearly 6%, approaching rates seen in cities. Rural residents most likely to be diagnosed include men aged 60-69, Black people, Alaskan Natives who live in high-poverty areas or Native Americans who live in the South and/or high-poverty areas. Meanwhile, lung, breast and colon cancer rates are falling in rural America. Read more here.

Telehealth may help smokers in rural prisons kick the habit, a study has found. Read more here.

A retired farmer's new book is a touching and often funny account of life on a farm. Read more here.

Study: Smoking rates have declined less among rural teens

Estimates of rural-urban difference in the prevalence of smoking
by high-school seniors, 1996-2021 (University of Minnesota chart)

Overall smoking rates continued to decline among teens from 1998 to 2018, but less so among rural teens, according to a newly published study in The Journal of Rural Health.

Smoking, the primary cause of preventable death, is more common in rural America. Since smokers typically begin the habit during adolescence, the researchers posited that higher smoking rates among rural teens contribute to significant long-term health disparities between rural and urban adults. They recommend that policymakers redouble their efforts to get rural teens to stop smoking or never start, since it could have big ramifications for rural morbidity and mortality rates down the line.

Researchers pulled data from 12th-grader surveys by the U.S. "Monitoring the Future" study from 1998 to 2018. Using the data, they estimated trends in the age of smoking initiation as well as how much the respondents smoke, both now and ever, and compared rural and urban estimates. 

Between 1998 and 2018, rural teens became far more likely than their urban peers to have ever smoked in their lifetimes. In 1998 rural teens were 6.9 percent more likely to have ever smoked, which rose to 13.5% in 2018—among the highest disparity in the past 20 years. 

However, over the past 20 years, the gap narrowed between rural and urban teens who had ever regularly smoked or currently smoke. The gap between rural and urban teens who had ever regularly smoked narrowed from 6.4% to 4.8% in the time period studied, while the gap between rural and urban teens who currently smoke narrowed from 5.5% to 3.0%.

Study: the more rural a place is, the higher the incidence of stroke risk factors, especially smoking among the poor

It's well-known that rural residents are at a higher risk of stroke. But a newly published study in The Journal of Rural Health examined the trend across rurality and found that, the more rural the place, the higher the prevalence of stroke risk factors such as hypertension, diabetes, heart disease, smoking, poverty, and more. Most interestingly, the study uncovered a link between stroke incidence and higher smoking rates, especially in poorer areas. 

Previous research has found that more rural areas have higher stroke mortality rates than more densely populated areas, but that's mainly because of a higher stroke incidence, not a higher case fatality, the authors write.

That said, health-care access disparities also worsen rural stroke survival rates, a 2020 study found. Small, rural hospitals often can't quickly transfer stroke patients to bigger hospitals with access to more experienced specialists and newer treatments, according to the study. 

Toolkit aims to help rural communities plan, create and fund early childhood health promotion programs

The Rural Health Information Hub has launched a toolkit to help rural communities learn how to plan, create and fund early-childhood health promotions.

The toolkit has seven detailed modules that break down how to create, develop and implement a program, evaluate its effectiveness, plan for long-term sustainability, and best practices. 

The toolkit is designed to supplement and expand on other rural community health toolkits dealing with food access, health promotion and disease prevention, obesity prevention, oral health, services integration, social determinants of health, telehealth, tobacco control and prevention, and rural transportation.

From the website: "For more information about rural community health programs, including how to develop and implement a program, please visit the Rural Community Health Toolkit. Visit the Rural Health Promotion and Disease Prevention Toolkit for information about implementing a health promotion program for people of all ages."

Study: covid-19 significantly worse among smokers

People who smoke are more likely to contract covid-19, the disease caused by the novel coronavirus, and more likely to have a severe case than non-smokers, according to a newly published analysis by University of California San Francisco scientists. That includes people who use e-cigarettes.

That has ominous implications for rural areas, where smoking rates are higher.

In a meta-analysis of recent studies about 11,590 covid-19 patients, the researchers found that current and former smokers were nearly twice as likely to see advanced progression of the disease, and more likely to die from it. "Smoking and e-cigarette use increase risk and severity of pulmonary infections because of damage to upper airways and a decrease in pulmonary immune function," according to the paper.

The authors recommend that physicians and public health officials collect more data on smoking and create smoking cessation initiatives to help blunt the impact of the pandemic.

Seniors live longer these days, but not as long in rural areas, and their lifespans lag many other developed nations

Life expectancy for seniors at age 65 increased across the board from 2000 to 2016, but not nearly as much in rural areas, according to a newly published data analysis.

Urban and coastal seniors survive much longer than seniors in rural areas and the nation's interior—especially areas like Appalachia and the East South Central states (Kentucky, Tennessee, Alabama and Mississippi). The geographic gap emerged around 1999 or 2000 and has been widening since 2000, Judith Graham reports for Kaiser Health News.

University of Pennsylvania demographer Samuel Preston spotted the trend using data from the Census Bureau and the National Center for Health Statistics. The longest-living seniors tend to be found in metro areas on the Pacific coast, and the ones with the shortest lifespans live in the rural East South Central states; the life expectancy gap between those two regions was nearly four years.

Men and women had differing life expectancies, according to co-author Yana Vierboom, a researcher at Germany's Max Planck Institute for Demographic Research; by 2016, "life expectancy at age 65 for women in large metropolitan areas was 1.63 years longer than for those in rural areas. For men, the gap was 1.42 years," Graham reports. "Disparities were also highlighted when researchers examined life expectancy at 65 in the U.S. and 16 other developed nations, using 2016 data. Overall, the U.S. was near the bottom of the pack: American men ranked 11th while American women were in 13th place, behind leaders such as Japan, Switzerland, Australia, France, Spain and Canada."

Preston's study identified a reduction in deaths from cardiovascular illnesses like strokes or heart attacks as the biggest reason Americans are living longer. Such illnesses are the number one cause of death in the United States. Preston speculated that rural seniors might be more apt to die from heart attack or stroke because of lack of medical access, and said smoking rates likely had an impact, too. The study did not consider race, income, or education, which probably play a role, Graham reports.

Study: Rural women with ovarian cancer more likely to be diagnosed at Stage IV, but not because of distance to doctor

Rural women who have ovarian cancer are more likely to find out about it when it's already at stage IV than women who live in metropolitan areas, according to a study in The Journal of Rural Health. That matters because detecting cancer earlier makes for a higher survival rate. From 2000 to 2015, the five-year survival rate of stage IV ovarian cancer was only 29 percent. The American Cancer Society estimates that 23,000 women were diagnosed with ovarian cancer in 2019, and about 14,000 died or will die from it.

Researchers from the University of Iowa and the Centers for Disease Control and Prevention studied a sample of about 1,000 women in Iowa, Kansas and Missouri who had been diagnosed with ovarian cancer in 2011-2012. At the time of diagnosis, 111 had stage IV and 889 had stages I-III. The stage IV patients were more likely to be older, rural, and have other health problems.

It is tempting to attribute that difference to poverty, or difficulty in accessing health care, but the study controlled for those factors. Rural women were more likely to be diagnosed with late-stage ovarian cancer regardless of their census tract's socioeconomic status or the distance to their primary care provider.

The diagnosis-stage disparity also isn't likely related to lifestyle factors such as smoking, obesity, or lack of physical activity; though such factors are more prevalent in rural areas, they aren't prominent risk factors for ovarian cancer. And though it's possible those lifestyle factors could create a higher incidence of cancer, they aren't likely to create geographic survival or diagnostic disparities.

Rural cancer patients overall have poorer outcomes than non-rural patients, including a lower survival rate. That's true of rural ovarian cancer patients too, probably because of lower access to specialty care and treatment after diagnosis.

The researchers suggest that better access to gynecological specialists in urban areas could make a difference, since those doctors are highly trained and may be able to recognize the symptoms of ovarian cancer sooner than other health care providers.

Some state legislatures tackle rural health access problems

Stateline map; click to enlarge it.

As state legislatures begin their 2020 sessions, more are grappling with how to increase access to medical care in rural areas.

Most rural areas have significantly worse health outcomes than cities and suburbs. Rural mortality rates for the top five causes of death (heart disease, cancer, accidents, low respiratory disease and stroke) and the gap has been growing at least since 2009, Michael Ollove reports for Stateline. Rural areas also have higher suicide rates. And though urban areas have a higher overall rate of deaths from drug overdoses, rural areas have higher overdose rates for some drugs, such as methamphetamines and oxycodone. Rural women are also more likely to die from a drug overdose than their suburban and urban counterparts.

The health gap has multiple reasons: poverty (which reduces access to health insurance and nutritious food), higher rates of smoking and obesity, and lower rates of exercise. Another big reason: "Since 2005, at least 163 rural hospitals have closed, more than 60 percent of them since 2012. Nineteen rural hospitals closed in 2019, the most in a year," according to the Rural Health Research Program at the University of North Carolina, which tracks rural hospital closures, Ollove reports. Rural health clinics are faring poorly, too: 388 clinics closed between 2012 and 2018, leaving 4,245 in operation.

Partly because of hospital closures, rural areas have a hard time attracting and keeping medical professionals. "Nearly 80% of rural counties are short on primary-care doctors, and 9% have none, according to the National Rural Health Association’s Policy Institute," Ollove reports. "The shortage of providers is likely to only get worse. More than 25% of primary care physicians in rural areas are 60 or older, compared with 18% in urban areas.

Though Medicaid expansion and the Patient Protection and Affordable Care Act have helped many rural residents get health insurance, rural areas are still grappling with these systemic problems. "Many states are focused on making improvements, both large and small, to address the deficiencies," Ollove reports. "Among the ideas: creating private-public partnerships to increase access to care, sending mobile medical units into remote areas, expanding telemedicine and encouraging young people in rural communities to go into health professions."

Several Republican-run states are fielding initiatives to expand Medicaid, which would increase rural coverage and thus rural hospitals' revenue. "Some states are trying to help rural hospitals deliver preventive care and chronic illness management beyond their walls, improving the collective health of the community while reducing health care costs," Ollove reports.

Pennsylvania, for example, has an initiative in which it guarantees 13 participating rural hospitals the revenue they'll receive in the coming year and rewards hospitals for keeping patients healthy and out of hospitals. The hope is that hospitals will be better able to focus on prevention and treatment without having to worry so much about the budget, Ollove reports.

"Brock Slabach, senior vice president of the nonprofit National Rural Health Association, said big ideas are needed to truly change the trajectory of rural health. The good news is that because of scale, rural areas are promising places to test out innovations in the delivery and financing of health care." But, he told Ollove, "we don’t have the luxury of having years to spend finding solutions."

E-cig crackdown could hurt mom-and-pop 'vape shops'

Washington Post map based on Yelp data; click on the image to enlarge it.

President Trump's proposed rackdown on electronic cigarettes could hurt small, independent shops that are "the fastest-growing retail segment of the past decade, as well as the one with the highest share of employees at small businesses," Andrew Van Dam reports for The Washington Post. "Two thirds of "vape shop" workers are employed by the 93 percent of businesses with fewer than 10 employees — a higher rate than for any other retail segment."

Tobacconists (the broader category that includes the shops) have far outgrown other retail segments over the past decade, according to Labor Department data. That's because of electronic cigarettes, according to online review site Yelp; it says the shops have been the fastest-growing large retail segment since the end of 2012. Yelp's data show that the shops are concentrated in the South and West, with the highest numbers in Nevada and Oklahoma.

In response to recent deaths related to electronic cigarettes and concerns about their appeal to teens, the Trump administration recently announced it will ban most flavored e-cigarette liquids. The governors of Michigan and New York have announced similar bans, which will kick in sooner. "Vape shops in those states are reeling," Van Dam reports. "Customers are racing to stock up on flavored liquids while store owners and employees ponder an uncertain future. Refills of liquids that e-cigs heat to the point of vaporization make up the bulk of these shops’ businesses, multiple managers said — and their adult customers overwhelmingly prefer flavored options."

E-cigarettes do not produce just a vapor, which is a gaseous form of a liquid; they produce an aerosol, in which particulates are suspended. The industry has branded itself with "vape" and "vaping."

Since vape shops open mainly combustible-cigarette smokers seeking alternatives, the shops could be as disproportionately rural as smoking is, and a federal ban on flavors could hit many small-town vape shops hard. Ryan Brown, who manages one such shop in Iron Mountain, Mich. (pop. 7,000), told Van Dam the shops are a major source of support for local community events and even helped fix up the disc golf course. If the flavor ban goes through, "It’s going to affect our town," he said. "They rely on mom-and-pop stores to keep these mining towns going when the mines are gone. Imagine how much tax revenue they’re going to lose."

Mom-and-pop stores could also lose out when the Food and Drug Administration begins requiring approval for electronic-cigarette liquids already on the market, a bureaucratic step that could cost between $117,000 and $466,000. Expensive regulatory barriers could wipe out small businesses and leave only the largest vaping companies like Juul on the market, Van Dam writes.

Ky. health foundation makes available to anyone TV and radio spots with youth talking about electronic cigarettes

The Foundation for a Healthy Kentucky has released four new public service announcements in its campaign to show the dangers young people subject themselves to by using electronic cigarettes. The spots are part of the foundation's "I Just Didn't Know" campaign and feature Kentucky teens. The campaign materials are free to anyone who would like to use them.

The new PSAs include two 30-second videos for television and a 30-second and 60-second audio PSA for radio. Additionally, the campaign can provide PSAs that were released in April.

In one PSA, Hayley, from Grant County in the rural part of Northern Kentucky, says, "A lot of people don't know that one little pod of this e-cigarette is equal to a whole pack of cigarettes."

Research shows that public health campaigns can play a crucial role in reducing tobacco use among teens. A 2018 federal report said one in five high-school students and one in 20 middle-school students used e-cigarettes, a 78 percent jump for high schoolers over 2017 and a 48% jump for middle schoolers.

E-cigarettes do not release harmless vapors, but instead contain substances such as: ultrafine particles, which can be inhaled deep into the lungs; flavorings such as diacetyl, a chemical linked to serious, irreversible lung disease; volatile organic compounds, which are known to be carcinogenic; other cancer-causing chemicals; and heavy metals, including nickel, tin and lead, according to the Centers for Disease Control and Prevention.

E-cigs also contain high levels of nicotine, which is highly addictive and can harm young people's brain development and reduce attention span and impulse control. Nicotine use in adolescence can also prime the brain for future addiction to other drugs, says the CDC.

On Aug. 7, the Food and Drug Administration announced that it was investigating 127 reports of seizures, tremors, fainting or other neurological symptoms that may be related to electronic cigarettes, and have asked anyone who has experienced such symptoms to report them.

All the PSAs can be found at www.ijustdidntknow.org. Contact Alexa Kerley at 877-326-2583 or akerley@healthy-ky.org for broadcast-quality copies.

In e-cigarette documentary, premiering on CNBC tonight, Juul CEO apologizes to parents of teenagers who vape

Juul Labs CEO Kevin Burns, left, and NBC reporter Carl
Quintanilla tour a Wisconsin Juul facility. (CNBC photo)

A new CNBC documentary exploring the increasing popularity of electronic cigarettes, especially among teens, features a surprising message from one industry CEO: an apology.

Kevin Burns is CEO of Juul Labs, which has about 40 percent of the e-cigarette market. It sells liquid nicotine pods in sweet flavors that are a prime driver in getting teenagers to try vaping. Reporter Carl Quintanilla asked Burns what he would say to a parent whose child was addicted to Juul.

Burns, who joined Juul in late 2017, replied: "First of all, I’d tell them that I’m sorry that their child’s using the product . . . It’s not intended for them. I hope there was nothing that we did that made it appealing to them. As a parent of a 16-year-old, I’m sorry for them, and I have empathy for them, in terms of what the challenges they’re going through."

Angelica LaVito reports for CNBC, "The Food and Drug Administration has declared teen vaping an 'epidemic,' citing federal survey data that showed nearly 21 percent of high school students vaped last year. Former FDA Commissioner Scott Gottlieb and health care advocates blame the surge in teen vaping on Juul."

"Vaporized: America's E-cigarette Addiction" will first air tonight at 10 p.m. ET.

Rural Nebraska school district, fed up with e-cigarettes, adds nicotine to drug test for extracurricular activities

Google map, adapted

Use of electronic cigarettes among teenagers has skyrocketed in the past few years, and a rural Nebraska school district has instituted a controversial way to fight it: any student in grades 7-12 who wants to participate in extracurricular activities must submit to random nicotine testing, Margaret Reist reports for the Lincoln Journal Star.

That will affect about 60 percent of the 387 students at Fairbury Junior-Senior High, about 50 miles southwest of Lincoln. The district has already had a random drug testing policy for the past two years, so nicotine will simply be added to the list of substances to be tested for. Students and their parents must sign a consent form for the testing in order to participate in extracurricular activities.

The board of Fairbury Public Schools approved the measure last week. "Vaping and smoking in our view is reaching epidemic proportions," Superintendent Stephen Grizzle told Reist. "It’s just a way we can deter kids from potentially being addicted to nicotine." He said adding nicotine to the drug testing panel will cost the district about $900 a year, and said the district is also considering installing sensors in the bathrooms that would detect e-cigarette vapor and notify administrators.

Though teenagers and privacy rights advocates might find it extreme, the new policy appears to be legal, under to a 2002 U.S. Supreme Court decision that upheld an Oklahoma school district’s policy of randomly drug testing students who participate in 'competitive' extracurricular activities such as cheerleading and choir," Antonia Farzan reports for The Washington Post. "In 1997, the Supreme Court had determined that testing high school athletes for illegal drugs was constitutional."

As move to make 21 legal age to buy tobacco gains steam, legislators and farmers debate impact on shrinking industry

A tobacco harvest in Kentucky (Photo by Greg Eans, Owensboro Messenger-Inquirer, via The Associated Press)

As longtime legislative supporters of tobacco follow manufacturers' lead toward making 21 the legal age to buy tobacco products, in the hope of avoiding greater regulation, some other legislators and tobacco farmers are worrying about what the future holds, reports Max Blau of Stateline.

More than a dozen states have passed "T-21" laws to raise the age from 18, and now Senate Majority Leader Mitch McConnell of Kentucky, a top tobacco state, has introduced a bill to make 21 the legal age nationwide and leave enforcement with the states. The bills are supported by tobacco companies such as Altria Group, the No. 1 manufacturer, which recently bought 35 percent of Juul Labs, maker of the electronic cigarette by far the most popular, especially with teenagers. Their logic: Raising the legal age will reduce the pressure for rules limiting flavorings, advertising and so on.

The companies' "about-face has worried some activists, who fear industry lobbying efforts behind such laws are intended to gut stronger local tobacco regulations," Blau notes. "Southern farmers are left to figure out what comes next. Some tobacco farmers wary of T-21 think the legislation is the latest threat to one of the region’s legacy crops. . . . Agricultural experts worry that the public health initiative could force farmers to grow less tobacco or push them out of the business."

Tony Banks, a Virginia Farm Bureau commodity-marketing specialist, told Blau, “It’s another step in the direction of hastening declines in cigarette consumption. And it’s another cut to [tobacco farmers’] production and income.” Supporters of T-21 say it won't have much impact on farmers because tobacco trades in an international market, but Steve Pratt, manager of the Kentucky-based Burley Tobacco Growers Cooperative Association, told Blau, “Obviously, anything that’s going to cause people to stop smoking is going to cause a decline in demand for burley tobacco,” Pratt said. “From that perspective, it’s definitely not going to help the tobacco farming industry.”

The industry has shrunk since the federal program of production quotas and price supports ended in 2004, and consolidated into larger farms. Pratt estimated the number of burley growers has plummeted from 175,000 to 3,000. And that has reduced the political influence of the crop that once had a powerful hold on Congress and state legislatures.

Journal of Appalachian Health begins publication, and it's about experiences in the region, not just research

Researchers in the College of Public Health at the University of Kentucky have started the Journal of Appalachian Health, an online, peer-reviewed journal, saying their overall objective "is to improve the health status of the population of Appalachia through the rapid dissemination of knowledge of their health problems and evidence-based solutions to them." The journal is available free to all readers, and all users are free to copy and distribute the material in any medium or format; and can remix, transform, and build on the material for any purpose.

"There is knowledge in the pages of Appalachia’s hills," the editors write in the first issue. "This journal is positioned to find and publish those translations. It grows from a need to provide an outlet for scholarship about Appalachia’s health so that knowledge, and occasionally wisdom, is shared with those who care about and are committed to improving the region’s health."

The journal's first article reports that children 7 to 9 years old in parts of Appalachian Ohio are almost five times as likely to be exposed to secondhand smoke as children in the nation, and that parents likely under-report the prevalence of smoking in their homes, based on blood samples taken from 404 children.

The journal is open to essays and commentaries as well as research reports. Jill Crainshaw of the divinity school at Wake Forest University writes about the experiences of students who have taken "a multicultural contexts course that includes a 10-day sojourn in the mountains of North Carolina. . . . The health and well-being of human communities are connected to the health and well-being of the geographic places where people live, work, and play."

Research shows which states, and which kinds of towns, have rural hospitals at most risk of financial distress

University of North Carolina map; click on the image to enlarge it.

The North Carolina Rural Health Research Program has released three new findings briefs about financial distress in rural hospitals. The program is administered by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

The first brief compares the percentage of rural hospitals at high risk of financial distress in each state. The map above shows each state's percentage range and number.

The second brief outlines the characteristics associated with communities served by hospitals at high risk of financial distress. Those communities tend to have higher minority populations, lower high school graduation rates, higher unemployment rates, and more adults who are obese, use tobacco, and/or suffer premature deaths.

UNC map; click the image to enlarge it. Refer to the third brief for definitions of different CMS reimbursement types.

The third brief shows trends in financial distress among rural hospitals from 2015 to 2019. It found that the proportion of rural hospitals predicted to be at high risk of financial distress increased from 7.1% in 2015 to 9.2% in 2019, especially in the South and especially among hospitals that rely more on Medicare reimbursements.

The brief also shows that hospitals with a Prospective Payment System now tend to be at greater financial risk than Medicare-dependent hospitals, though both types are at increasing risk (as shown above). In a PPS, the government reimburses hospitals for Medicare and Medicaid patients' care with a predetermined, fixed payment. A Medicare-dependent hospital is a small rural hospital that has at least 60 percent of its inpatient days or discharges attributable to Medicare beneficiaries and is not the sole hospital in a community.

Rural teens 50% more likely to smoke than urban teens

Though teen smoking rates among rural and urban teens have fallen, rural teens are still 50 percent more likely to smoke than their urban counterparts, according to a study newly published in the American Journal of Public Health.

"Using data from more than 95,600 adolescents who participated in the National Survey of Drug Use and Health, researchers analyzed smoking rates over two periods: 2008-2010 and 2014-2016. Fifteen percent of the youth lived in rural counties," Saumya Joseph reports for Reuters. "Teenage smoking in urban areas fell by half from the first period to the second, after accounting for socioeconomic factors such as gender, race, ethnicity and family income. But it only went down by a third in rural places."

The study didn't examine why more rural teens smoke, but earlier research has found that rural teens tend to have easier access to tobacco products, start smoking earlier and are more likely to have family members in their home who smoke, Joseph reports.

Smoking cessation efforts should pay attention to the differences in rural areas and try to understand better how policies and programs might work differently there, said lead study author Erika Ziller of the University of Southern Maine.

Study: low-income, rural kids may be at higher risk of cigarette smoke exposure than previously thought

A newly published study in Nicotine & Tobacco Research found that young children from low-income, rural homes could be at a higher risk of exposure to second- and third-hand cigarette smoke than previously reported. Secondhand smoke is smoke in the air that comes from a lit tobacco product; thirdhand smoke is smoke residue that settles into floors, furniture and clothing.

The study, funded by the National Institutes of Health, analyzed data from the Family Life Project, an ongoing longitudinal study of poor families in six rural counties of Pennsylvania and North Carolina who added a child between September 2003 and August 2004. Researchers measured levels of cotinine, which the body makes from nicotine, in the saliva of 1,218 children at ages 6,15, 24, and 48 months; about 63 percent had detectable levels, and about 12 percent had at least as much as one would expect to find in an active adult smoker.

"Greater exposure was associated with lower income, less education, more residential instability, and more instability in adult occupants in the home, whereas time spent in center-based day care was associated with lower exposure," the researchers write.

Greater residential instability correlates with higher smoke exposure because thirdhand smoke lingers, so a nonsmoking family that moves into a home once occupied by a smoker will likely be exposed to thirdhand smoke. Poverty is associated with frequent moves, which the researchers hypothesize could increase such children's risk of thirdhand smoke exposure. More time in a center-based daycare lowers the risks of smoke exposure; day-care centers are generally smoke-free.