Disparities Evident As Fairfield County Considers Its Community Wellbeing

Fairfield County’s sizeable immigrant population - twenty percent of Connecticut’s most populous county - grew 89 percent from 1990 to 2014. In some municipalities, foreign-born residents make up as much as a third of the population. That is among the findings in the Fairfield County Community Wellbeing Index 2016, which examined regional demographics, economic opportunity, education, health, quality of life, and happiness.  The report includes analysis of the communities, populations, and neighborhoods of Fairfield County, as well as opportunities available and issues facing the area.

Since 1980, the size of the population living in neighborhoods that are considered most affluent – defined as those with an average family income more than 2.5 times higher than the state level - has tripled within Fairfield County. Meanwhile, the number of people living in poor neighborhoods is 3.5 times its 1980 size. The number of people in middle-income neighborhoods has decreased by sixteen percent.

Fairfield County’s Community Foundation, a major funder of the report, partnered with DataHaven, area hospitals, and government agencies to help launch a more robust and comprehensive resource that could serve as a part of the hospitals’ and health departments’ Community Health Needs Assessments as well as a broader county-wide indicators program.

“Fairfield County’s Community Foundation is committed to addressing the most pressing issues facing Fairfield County, but to do that we first need to be able to identify and understand those issues,” stated Nancy M. von Euler, Vice President, Programs, Fairfield County’s Community Foundation. “The data in the Fairfield County Community Wellbeing Index 2016 will help us to develop priorities for collective action to build a stronger, healthier Fairfield County where everyone has the opportunity to thrive, regardless of their zip code.”

The report states that "Despite its overall affluence, Fairfield County is among the nation’s most unequal metropolitan areas. Inequities in well-being appear when evidence is stratified by income, age, race, gender, and zip code. These differences are often most apparent after considering data that were collected specifically for the age groups and neighborhoods that are most impacted."

Among the findings, between 2014 and 2025, adults ages 65 and over are Fairfield County’s only age group projected to grow significantly, with a thirty-seven percent increase. Disparities in the County were also evident:

• High and rising childcare costs are often prohibitively expensive for low and middle-income families. While Fairfield County has nearly enough spaces for all 3- to 4-year-olds to attend preschool, there are only enough regulated childcare slots for fifteen percent of the county’s children ages 0 to 2, and enough subsidized slots to cover only twenty-two percent of these youngest children in low-income households.

• The issue of dental care arose as an indicator of well-being, particularly among younger adults and families. The Index shows that for every 10,000 residents living in Fairfield County, 12 residents visit an emergency room to receive treatment for preventable dental conditions in any given year, whereas on the East Side of Bridgeport, 178 residents do.

• Fairfield County residents are healthy when compared to national benchmarks. However, many conditions and risk factors—such as asthma, food insecurity, exposure to community violence, and the early onset of diabetes—are disproportionately prevalent in lower-income neighborhoods and communities of color. Sections of Bridgeport in particular fall very far behind the surrounding area in many of these measures.

• Disparities in access to reliable transportation persist between racial and income groups. A majority of Fairfield County workers, regardless of income, commute to another town for work. Many low-income (annual wages under $40,000) workers leave Bridgeport for work, while large shares of high-income workers commute to New York City.

“The process of developing this report allowed local partners and community members to identify links between the well-being of residents and the places where they live. Looking beyond typical measures like income levels or unemployment rates, the Community Wellbeing Index reveals a much more uneven distribution of opportunities in areas such as neighborhood walkability, economic development, public health, and education,” said Mark Abraham, Executive Director of DataHaven and a lead author of the report. “The impact that these barriers to opportunity have on overall well-being and happiness will serve as a call to action for many groups working to improve Fairfield County’s diverse neighborhoods and towns.”

The Fairfield County Community Wellbeing Index 2016 was based on a variety of federal and statewide data sources. Partners of DataHaven’s Fairfield County Community Wellbeing Index 2016 include Fairfield County’s Community Foundation; Bridgeport Hospital; Danbury Hospital; Greenwich Hospital; Norwalk Hospital; St. Vincent’s Medical Center; and Stamford Hospital.

Healthy Eating Not So Great Among Children, Community Can Help

Only one-third of parents of children ages 4-18 feel they’re succeeding at fostering healthy eating habits in their kids, according to a recent national survey.  The University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health found that just over half of parents believe their children eat mostly healthy, and only one in six parents rate their children’s diets as “very nutritious,” according to a press release. A fourth of parents polled said their child’s diet is “somewhat or not healthy at all.” Common challenges – not surprisingly - get in the way, according to experts: price, picky eaters and convenience.

“Most parents understand that they should provide healthy food for their children, but the reality of work schedules, children’s activities and different food preferences can make meal preparation a hectic and frustrating experience,” poll co-director Sarah Clark explained. “The tension between buying foods children like, and buying foods that are healthy, can be an ongoing struggle. Many of us know the feeling of spending time and money on a healthy meal only to have our children grimace at the sight of it and not take a single bite.”

Other data from the poll – which involved 1,767 parents – include that one in five parents don’t think limiting their child’s intake of fast food or junk food is important, and that 16 percent said limiting sugary drinks is “somewhat or not important.”

In general, parents of teens were less worried about unhealthy eating habits compared to parents of younger children.

The C.S. Mott Children's Hospital National Poll on Children's Health measures current national public opinion, perceptions and priorities regarding major health care issues and trends for U.S. children and people in their communities.

Also this month, the Rudd Center for Food Policy and Obesity at the University of Connecticut found that residents of one Maryland county bought fewer sugary drinks after a campaign to reduce the consumption of sugar-sweetened beverages that included policy changes and public health outreach efforts.

The Rudd Center study, published in JAMA Internal Medicine, is the first to use objective retail sales data to measure the effectiveness of a community-led campaign to reduce consumption of sugary drinks.

“This study demonstrates the power of a community-based public health campaign that combines health-supporting policy changes with extensive outreach. The residents of Howard County have been engaged in every phase of this effort and their commitment to switching their drinks showed up in the supermarket sales data,” said Marlene Schwartz, Director of the UConn Rudd Center for Food Policy and Obesity, and the study’s lead author.

Beverages with added sugars are among the leading sources of empty calories—calories that supply little or no nutrients—for both children and adults, and overconsumption of sugar is associated with obesity and increased risk of heart disease.

The study’s key findings show that based on sales data from Howard County supermarkets:

• Sales of sugar-sweetened soda declined nearly 20 percent.
• Sales of 100 percent juice fell 15 percent.
• Sales of fruit drinks with added sugars fell a little more than 15 percent.

Comparing sales data in 2012, before the Howard County Unsweetened campaign, to sales data in 2015, researchers found notable declines in purchases over the three-year period.

In determining the campaign’s impact, researchers compared weekly beverage sales of top-selling brands in 15 Howard County supermarkets with a matched group of 17 supermarkets in southeastern Pennsylvania. The study did not include sales data from non-supermarket vendors such as convenience stores.

The Rudd Center for Food Policy & Obesity at the University of Connecticut is a distinguished multi-disciplinary policy research center dedicated to promoting solutions to childhood obesity, poor diet, and weight bias through research and policy.  The study was funded primarily by the Horizon Foundation, with additional funding from the Robert Wood Johnson Foundation, and from the Rudd Foundation to support data collection. Voices for Healthy Kids, a joint initiative of the Robert Wood Johnson Foundation and the American Heart Association, is a strategic partner of both Howard County Unsweetened and Sugar Free Kids Maryland.

CT Ranks 5th in U.S. in Dental Health, Best in New England

The neighboring states of Minnesota, Wisconsin, Illinois and North Dakota have the best dental health in the nation, but Connecticut and Massachusetts break the mid-west logjam, ranking fifth and sixth in a new survey of nearly two dozen dental-health related categories by the financial website WalletHub. Connecticut ranked second in a series of oral health categories and 17^th in a group of dental habits and care categories, according to the survey, resulting in the 5th place finish overall.  Connecticut and Massachusetts ranked one-two in the highest percentage of adults who visited a dentist in the past year, and Connecticut placed third, after New Hampshire and Pennsylvania, in the highest percentage of adolescents who visited a dentist in the past year.

Connecticut also topped the list in two additional categories:  Lowest Percentage of Adults Who Experienced Pain in the Past Year Due to Oral Condition and Lowest Sugar-Sweetened Beverage Consumption Among Adolescents.  The state also ranked in a tie for third for having the lowest percentage of elderly population with no natural teeth.

Data used to create the ranking were collected from U.S. Census Bureau, Bureau of Labor Statistics, Centers for Disease Control and Prevention, Healthy Grid, American Dental Association, Health Resources & Services Administration, Medicaid and CHIP Payment and Access Commission, American Academy of Pediatric Dentistry and Oral Health America, according to WalletHub.

With the state’s ranking in the background, the Connecticut Oral Health Initiative (COHI) will host a session on health equity during Oral Health Day at the State Capitol on Wednesday, March 8, from 10 am to 3 pm in the Legislative Office Building.

Connecticut oral health-related organizations will on hand throughout the day to raise awareness and educate decision-makers and the public about policies to improve the oral health of Connecticut residents. The organization’s focus this year is on preserving Medicaid coverage for adults and children, allowing children to remain on their parents' dental insurance until age 26, and integrating oral health into health systems.

Other legislative initiatives include a proposal to increase the number of adults aged 19 to 26 years covered by dental insurance to provide continuity of dental care into adulthood, and another to decrease the incidence of oral and other cancers by decreasing tobacco use by Connecticut residents. By raising the Legal Age For Purchase and Use of Tobacco Products.

COHI leads and collaborates in statewide oral health advocacy efforts; promotes the necessity of oral health to overall health; serves as an expert resource on oral health policy; and publicizes oral health policy analysis and recommendations.

Also at the Capitol, the Department of Public Health is proposing a mandate for dental hygienists to have at least one contact hour in cultural competency prior to the renewal of their license, as part of the commitment to health equity.

Health Reform Efforts Earn CT a C+, Survey Says

Connecticut health care thought leaders have again given the state a C+ grade for health reform, as the state’s GPA dropped slightly  from 2.4 to 2.2. Connecticut’s grade for effort didn’t change from last year – holding steady at a B-/C+ (GPA 2.5) in the annual survey by the Connecticut Health Policy Project, as part of their efforts to increase public awareness of health care issues among state residents. Connecticut continues to earn higher marks for Medicaid and the health insurance exchange, according to the survey. Grades for patient-centered medical homes were down from recent years. Lowest marks went to efforts to address the health care workforce, the only area that received a D grade overall.

Unlike past years, thought leaders gave more C’s across the majority of issue areas, mirroring the overall grade for the first time. A new question assessing the level of trust between stakeholders in Connecticut health policymaking elicited low responses, averaging only 26 out of 100 possible points, with zero to ten being the most common response. Low trust scores were found in every stakeholder group.

The Connecticut Health Policy Project is a non-profit, non-partisan research and educational organization dedicated to improving access to affordable, quality health care for all Connecticut residents.

Sixty-one thought leaders across Connecticut’s health fields and sectors were surveyed online between December 20, 2016 and February 9, 2017. Forty-one (67%) responded. The invitation list was collected from membership of health-related state councils, board and committees, and leadership of health-related organizations.

Respondents represented community organizations, foundations, providers, payers, consumer advocates, labor, media, business people, insurance brokers, and academics. To ensure independent responses, state officials responsible for reform were not surveyed, officials said.

Health Consultants For Pre-School Age Children Can Improve Health; Report Urges Policy Changes in CT

Research shows that the presence of a health consultant, usually a nurse by training, in child care centers leads to positive outcomes including improved nutrition, better sanitation and infection control, increases in access to preventive health care, specialty health care, mental health care, and oral health services. That’s according to a report by the Child Health and Development Institute (CHDI), which recommends health consultation as a “key strategy for integrating health into early learning systems and maximizing the contribution of early learning programs to children’s healthy development.”

“We rely on child care health consultants to ensure children’s health and safety in early care settings according to child care licensing regulations, but these providers are not fully supported nor utilized by our child health systems,” said Lisa Honigfeld, co-author of the report and vice president for health at CHDI. “Policy reform can strengthen and expand the role of child care health consultants to connect parents, child health providers, and child care centers to better promote health and developmental outcomes for children.”

CHDI’s “IMPACT, Promoting Children’s Health in Early Care and Education Settings by Supporting Health Consultation,” summarizes research on the role and benefits of health consultation in early learning settings, and reviews policies, regulations, training, and payment structures used in Connecticut and other states. The report concludes that Child Care Health Consultants (CCHC) can be “instrumental in contributing to the achievement of pediatric population health goals in Connecticut by monitoring the health of young children at the community level and contributing to community health system efforts.”

The 30-page report provides a framework for Connecticut to integrate health into early learning systems by taking advantage of opportunities presented as part of the state's overall health reform efforts. Recommendations include:

1. Develop infrastructure within the State to support health consultation with training, reimbursement, and quality improvement.
2. Strengthen licensing requirements to collect and report detailed health consultation information for all licensed child care sites.
3. Advocate for inclusion of CCHCs in Connecticut’s health reform plans.
4. Use a multi-disciplinary oversight group to develop a system of health consultation services to the meet the needs of Connecticut’s child care programs.

The report notes that a majority of children younger than age five spend “significant time” in early care and education settings, with more than 98,000 children enrolled in licensed child care centers, Head Start programs, and family child care homes.

“Unlike mental health consultation,” the report states, “overall health consultation is not supported with state level infrastructure and payments for health consultants to early Childhood Education sites. For private child care or preschool programs, the cost to hire a health consultant is borne by the program, with no system in place to ensure the quality of the CCHC workforce or ensure that health consultation is implemented to maximize the health and safety of children in child care.”

Connecticut regulations allow child care sites to employ a registered nurse, advance practice registered nurse, physician, or physician assistant to serve as the site’s health consultant.  Child care licensing requires child care sites that serve children ages three to five have quarterly health consultation visits.

Indicating that “several states and initiatives are testing innovations to better support integration of primary care medical services and community services,” the report suggests that “Connecticut, too, is poised to promote increased cross-sector collaboration in early childhood,” citing the establishment in 2013 of the Office of Early Childhood at the state level, which brought under one roof a range of services and responsibilities that had been housed in a number of different state agencies.

In most states, including Connecticut, a CCHC is typically a licensed registered nurse, according to a survey of states undertaken for the report.  Two states (Hawaii and Indiana) require that the CCHC be a physician, the research found, and four states (Illinois, Maine, Maryland, and North Carolina) allow licensed practical nurses to be health consultants. North Carolina allows other disciplines (sanitarian, nutritionist, and dietician) to be trained and credentialed as a health consultant.

The report points out that “CCHCs need specialized training, skill sets, and experience to address health issues for individual children and for the group setting as a whole. They also need to be aware of health and community resources so they can link child care facilities and families to appropriate services when needed. Programs with a significant number of non-English speaking families benefit from the services of a CCHC who is culturally sensitive and knowledgeable about community health resources for parents’/guardians’ native cultures and languages.”

The Child Health and Development Institute of Connecticut (CHDI), a subsidiary of the Children’s Fund of Connecticut, is a not-for-profit organization working “to ensure all children have a strong start in life with ongoing supports to ensure their optimal health and well-being.” CHDI advocates for “effective policies, stronger systems, and innovative practices.”

Combating Opioid Epidemic in Connecticut Schools - Officials Team Up for Educators Workshop

The Connecticut Association of Schools (CAS), in partnership with the U.S. Attorney's Office, the FBI, the Drug Enforcement Agency (DEA), and victims of drug abuse, will be offering a one-half day workshop for administrators, teachers, and counselors on the devastating opioid epidemic that is growing in severity in Connecticut an across the country. This video-based educational program is designed for high schools and geared specifically for teens and adolescents, officials explain, and will be accompanied by an educator’s discussion guide. The guides will be available for participants to immediately use in a variety of educational settings.

Projections for 2016 by the State Medical Examiner indicate that close to 900 people died of accidental drug overdoses in Connecticut. That is almost three times the number of people who died in car accidents last year, organizers point out. Even more devastating, they note, is the fact that a majority of these deaths are of young people ages 18 to 25, many of whom developed an addiction to opioids after misusing prescription pills while in their teens or early adolescence. Sports injuries, dental pain and other illnesses are common reasons for the original prescription.

According to the Centers for Disease Control and Prevention, opioids were involved in 33,091 deaths nationwide in 2015, and opioid overdoses have quadrupled since 1999.Significant increases in drug overdose death rates from 2014 to 2015 were primarily seen in the Northeast and South Census Regions. States with statistically significant increases in drug overdose death rates from 2014 to 2015 included Connecticut, Florida, Illinois, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Washington, and West Virginia.  In Connecticut, between 2014 and 2015 the rate increased by 25 percent.  

Recognizing that law enforcement is only one facet of the solution, the U.S. Attorney’s Office is fighting this epidemic on several fronts, including criminal prosecution and outreach to schools for prevention, officials said. The office has formed a Heroin Education Action Team (HEAT), which includes parents of local overdose victims, to further assist in this effort.

“Opioid Epidemic in CT – Stemming the Tide” will take place on March 3, 2017, 8:30 to 11:00 a.m., at the CAS-CIAC Conference Center in Cheshire.  Registration deadline is February 24, 2017; the cost is $15.00

CAS officials are also calling for schools to show, “as soon as possible, and no later than the end of the school year,” videos about the crisis.

“Please ensure that every student in your high school sees at least one of the following two films,” the association urges:

• 1) a 15-minute film called The Opioid Crisis Hits Home: Stories from Connecticut that can also be used to educate educators, parents and the general public about the opioid epidemic; and
• 2) the FBI/DEA documentary film Chasing the Dragon: The Life of an Opiate Addict, which is 45-minutes long and accompanied by an educator’s discussion guide geared specifically to teens and adolescents.

Since last September, a number of Assistant U.S. Attorneys have partnered with parents of overdose victims, young recovering addicts, FBI, DEA, and local law enforcement to facilitate Chasing the Dragon presentations at high schools in Milford, New Haven, Danbury, Plymouth, Shelton, East Hartford and New Fairfield.

The films “are provided as a public service for the sole purpose of saving lives,” officials underscore. School officials can schedule an opioid awareness presentation by contacting  Assistant U.S. Attorneys Vanessa Avery or Robert Spector at 203-821-3700.

The Connecticut Association of Schools,  a non-profit, tax-exempt educational organization, has grown to represent well over 800 of Connecticut’s public and parochial schools.

First Television, Now Picture Books – Contributors to Less Healthy Eating Among Children

Concerns about the impact of television promoting products such as snack food and soda have been well documented for some time, but academic research is now suggesting another culprit for childhood obesity and a growing lack of healthy eating among youngsters. Children’s picture books – the books filled with brightly colored drawings and basic themes that are staples of bedtime stories, pre-school readings and local story hours.  How they depict food – and eating – has led a UConn researcher to raise red flags.

The study – conducted by Jane Goldman, professor emerita in UConn’s Department of Human Development and Family Studies, and Lara Descartes, a former assistant professor with the department and now a professor of Family Studies at Brescia University College in Canada – found that while the ratio of healthy to unhealthy foods depicted in books is higher than it is on television, books more often link positive events and concepts – such as love and nurturing – to treats, such as ice cream and baked goods, rather than fruits or vegetables.

The findings were first published a year ago in the journal Appetite and were the subject of presentations last fall by Goldman and Descartes at the University of California at Irvine and a global conference on food in the United Kingdom, and reported this month by UConn Today.

“It’s not that you shouldn’t have ice cream in books, but people should be aware of what the underlying message is,” Goldman said. “What are the messages children are getting about foods when a picture book is read to them, and are those messages related to the obesity epidemic among children?”

The researchers evaluated 100 picture book titles in Scholastic’s “Favorite Books for Preschoolers” collection – a mix of classics and newer titles, fiction and non-fiction. Sixty-nine of the 100 books in the collection included one or more food items in the text and/or illustrations. Although “the ratio of healthy foods to nutrient-poor foods was higher in the books,” according to the researchers, there was bad news as well as good in their findings.

Goldman and Descartes first identified books in which food is mentioned one or more times – 48 titles fit into that category – and others in which food is a theme or sub-theme, a group that included 21 titles. The pages on which food is mentioned were then coded based on the placement of the food, or centrality; the level of emotion expressed, or affect; and the number of times, or frequency, with which the food is mentioned. Using characters’ expressions as a guide, researchers assigned a rating of positive, negative, or neutral to each food reference.

The researchers found that vegetables are depicted in more than a third of the books and centrally portrayed in more than half, but only 18 percent of the depictions received a positive “affect” rating.  Conversely, sweetened baked goods are both centrally positioned, and have a positive “affect” about 80 percent of the time.  And ice cream, although not in many books, always was associated with positive outcomes - five of the seven times ice cream is mentioned, it’s offered as a treat, to make someone feel better, or as a happy ending.  Among the other findings:

• Almost all 69 picture books in the sample depict one or more healthy foods.
• Twenty-nine (42 percent) depict only healthy foods; and thirty-three (48 percent) depict both healthy and nutrient-poor food, but the majority of the depictions are healthy foods.
• Fruits, while depicted in more than half the books, are most often in the background, and only one-third of fruit depictions received a positive “affect” rating.

The researchers say it’s important to look at the context in which foods are presented as well as the frequency, observing that the people they interviewed rarely noticed that food was mentioned in children’s books, nor what messages were being conveyed, UConn Today reported.

Goldman was not surprised, UConn Today reported, that many of the picture books surveyed in the study portrayed sweet and comparatively unhealthy foods as very desirable or that they were associated with positive outcomes.  When nutrient- poor foods are presented both frequently and positively, she indicated, it may well contribute to children’s view of them as more desirable.  This is especially likely given the fact that picture books are just one part of a child’s total media consumption and that television content is known to promote a positive association with nutrient-poor foods.

“What we hope the study  does is make people aware of how food is presented in picture books, in the same way they have become aware of how gender roles are presented in books,” Goldman says. “Books are a tool we use all the time, so how can we use books to promote healthy ideas about food. In early childhood there is an emphasis on helping children read and on healthy eating and lifestyle, so why not think about the messages in books that support or contradict that healthy lifestyle message.”

CT Is 35th in Well-Being Among the States, Slipping Lower in Rankings

Connecticut ranks 35th in well-being among the 50 states, according to a new Gallup-Healthways 2016 State Well-Being Rankings report.  That’s a drop in the rankings for Connecticut, which averaged a 28th place finish over the past three years. In 2016, Connecticut had a Well-Being Index score of 61.7, which is lower than the national Well-Being Index score of 62.1.  The report, which is part of the Gallup-Healthways State of American Well-Being series, examines well-being across the nation, including how well-being varies by state and which states lead and lag across the five elements of well-being.  They are:

1. Purpose — Liking what you do each day and being motivated to achieve goals
2. Social — Having supportive relationships and love in one’s life
3. Financial — Managing one’s economic life to reduce stress and increase security
4. Community — Liking where you live, feeling safe and having pride in your community
5. Physical — Having good health and enough energy to get things done daily.

Hawaii ranked the highest in well-being, followed by Alaska, South Dakota, Maine, Colorado, Vermont, Arizona, Montana, Minnesota and Texas.   Hawaii’s 65.2 was the highest score in the past three years.  Hawaii led the nation in financial, community and physical well-being. Alaska and Texas led thenation in social and purpose well-being, respectively.

West Virignia ranked the lowest, and other states at the bottom of the list included Oklahoma, Kentucky, Indiana, Arkansas, Ohio and Alabama.

In a category-by-category review, Connecticut ranked 13th in physical, 19th in social, 37th in financial, 45th in purpose, and 48th in community.

“[Well-being] can be a force multiplier to the bottom line by directly influencing healthcare costs, resilience, and retention as well as to the top line through factors such customer satisfaction, sales and innovation,” said Michael Thompson, the President and CEO of National Alliance of Healthcare Purchaser Coalitions.

Well-being in the United States continues to exhibit regional patterns with the Northern Plains, Mountain West and some Atlantic states generally reporting higher levels, while states in the South and Midwest consistently lag in certain elements.  The only New England state ranking lower than Connecticut was Rhode Island, at number 42. Rhode Island had the lowest social and community well-being categories.  Massachusetts ranked 14^th  overall, improving from an average 20^th place ranking in recent years.

Among the positive trends identified include historically low smoking rates (now at 18.0%, down from 21.1% in 2008); historically high exercise rates as measured by those who report they exercised for 30 minutes or more, three or more days in the last week; and the highest scores recorded on healthcare access measures, with the greatest number of Americans covered by health insurance and visiting the dentist. Americans are also reporting the lowest rates of healthcare insecurity since 2008, as measured by not being able to afford healthcare once in the last 12 months.

The report noted that married people have the lowest rates of depression (13.4%) and sadness (13.5%), and the highest rates of enjoyment (87.8%) and happiness (91.3%), compared to people from any other marital status. Adults with children living at home are more stretched emotionally, reporting more worry and stress on any given day, but also more happiness, smiling, and laughter.

In addition, the report noted that more Americans say they use their strengths on a daily basis, say their supervisor treats them like a partner, and creates a trusting and open environment than in any other year since 2008.

Lembo Develops Plan Aimed at Bringing Drug Costs Within Reach

State Comptroller Kevin Lembo, after what was described as “exhaustive research and consultation with representatives across all sectors of the health care industry,” has developed a five-point plan to address “skyrocketing pharmaceutical drug costs.” Lembo’s proposed legislation, which is to be considered by legislators in the five-month session that began earlier this month, aims to be comprehensive in addressing a range of interrelated issues.  Those issues include requiring justifications for sharp price increases, establishing oversight of drug costs that exceed certain thresholds, ensuring that consumers benefit from rebate savings, promoting insurance plans that emphasize affordable co-pays and preventive care, and eliminating incentives that perversely encourage providers to prescribe the most expensive drugs.

“In a divided country,” Lembo said, “when we’re desperate to find common ground, virtually everyone can agree that prescription drug costs are out of control and must be fixed.  This rise in patient cost share, combined with the rising prices of pharmaceuticals is creating a significant financial burden for Connecticut residents,” Lembo added, noting that “consumers are increasingly bearing a greater share of those costs.”

Lembo, who served as Connecticut’s first Healthcare Advocate prior to being elected State Comptroller in 2010, currently administers the state health plan on behalf of approximately 200,000 people.  The plan includes:

• Require pharmaceutical manufacturers to justify launch prices and price increases over a certain threshold

To address rising drug prices that appear to be arbitrary and unjustifiable, Lembo proposes a requirement that when drug manufacturers increase prices beyond certain thresholds, (for example, list prices increase over 50 percent in the last five years or 15 percent in the last year or launch prices 30 percent or more above the average price for other drugs in a therapeutic class) they must provide the state with information about total costs for producing specific drugs and costs for research and development, marketing, different prices charged for the drug, total profit from specific drugs, research and development efforts that have not resulted in any approved drugs, details about discounts and rebates provided and, of course, a justification for the launch price or the price increase in question.

The findings of a state review would be reported to the legislature and governor to evaluate the appropriateness of the price increases in question.

• Limit the launch price and annual increases of certain high cost drugs

Establish a working group to evaluate the potential of using the information reported above to regulate drug prices in certain egregious instances through the creation of a state-level drug price review board. The authority would review the launch prices of new drugs and annual increases of existing drugs that exceed certain thresholds. The working group should recommend a process for determining if the launch prices or price hikes are justified and recommend possible state actions to take when increases are deemed unjustified.

• Promote the adoption of value-based insurance design

The state Department of Insurance (DOI) and the state health exchange should be required to promote the adoption of plans that use a value-based insurance design. Value-based insurance for prescription drugs generally encourage medication adherence by reducing or eliminating co-payments and deductibles for drugs that help control chronic conditions.  Better managed chronic diseases reduce in-patient hospital stays and emergency room visits by individuals with chronic diseases. The state employee plan has seen significant increases in medication adherence since adopting a lower co-pay structure for maintenance drugs through the state Health Enhancement Plan.

• Allow consumers to benefit from negotiated drug rebates.

Require health plans to base co-insurance and deductible payments on the net price of the drug, post rebate, rather than the list price, allowing the consumer to share in rebate savings negotiated by the pharmacy benefit manager or plan administrator.  For certain highly rebated drugs the list price can be as much as three times more than the final price paid by a health plan after manufacturer rebates.

• Remove incentives for physicians to administer higher cost drugs.

In 2004, Medicare began to reimburse physicians 6 percent of the acquisition cost of drugs for administration. Commercial payers, which often base their reimbursement policies off Medicare, quickly followed suit. The new policy created a perverse incentive in which physicians were paid more for using more expensive drugs even when lower cost equally effective alternatives were available. It also incentivized drug manufacturers to significantly increase prices. As a result, many physician-administered drugs have seen massive price increases since 2004, with many oncology drugs well in excess of $100,000 per regimen. The state should require state-regulated insurance plans to completely delink the reimbursement for physician-administered drugs with the costs of the drugs administered in order to eliminate such perverse incentives.

“This plan emphasizes transparency, accountability and common-sense health care policy that puts quality and wellness for everyone above the corporate profits of big Pharma,” Lembo said in recommending the five-part plan.

Over the past several years, Lembo has been working with state leaders and Connecticut’s congressional delegation to investigate flaws in the pharmaceutical market and implement policies to address the problem.   Last year, he co-hosted a forum at the State Capitol with the Connecticut State Medical Society (CSMS) that brought together physicians, pharmaceutical companies, academicians, patient advocates and other industry experts to address the skyrocketing cost of medications.

Lembo also serves on a working group of the NASHP (National Academy for State Health Policy), which recently issued a report recommending proposed state action, some of which is reflected in Lembo’s legislative proposal.  The Office of the Healthcare Advocate, which Lembo led for six years a decade ago, is an independent agency that helps consumers when they have disputes with their health insurance company. They also educate people about their health care rights and serve as a watchdog over Connecticut’s healthcare marketplace.

Financial Cost to Connecticut Smokers Among Highest in the Nation

The financial cost of smoking in Connecticut is higher than just about anywhere in the United States.  The total cost over a lifetime per smoker is $2,183,204, the third highest in the nation, and the annual cost per year per smoker of $42,808, is also third highest in the nation, just behind New York and Massachusetts. The lifetime health care cost per smoker, $274,272 in Connecticut, is higher than every state but one, (Massachusetts), and the out-of-pocket cost per smoking individual of $170,513 for smokers living in Connecticut is third highest in the nation.

The data was compiled by the financial website WalletHub, where analysts calculated the potential monetary losses — including the cumulative cost of a cigarette pack per day over several decades, health-care expenditures, income losses and other costs — brought on by smoking and exposure to secondhand smoke. 

Emphasizing that “the negative physical and financial effects of smoking can be significant,” WalletHub noted that Connecticut’s rankings placed it as among the most costly in every category.

Over a lifetime, the financial opportunity cost for smokers living in Connecticut was $1.436,335 and the income loss per smoker was calculated at $286,950.  Other costs per smoker, such as not being able to qualify for homeowner’s insurance discounts for non-smokers, were $15,133.  In each instance, the costs in Connecticut were among the three highest among the 50 states and District of Columbia.

Annual income loss for Connecticut smokers is calculated at $5,626.  Only Maryland, Alaska, New Jersey and D.C. were higher, according to the analysis. Attributable factors included absenteeism, workplace bias or lower productivity due to smoking-induced health problems.  The website also noted that according to a recent study from the Federal Reserve Bank of Atlanta, smokers earn 20 percent less than nonsmokers, 8 percent of which is attributed to smoking and 12 percent to other factors.

For the calculations, WalletHub assumed an adult who smokes one pack of cigarettes per day beginning at age 18, when a person can legally purchase tobacco products in the U.S., and a lifespan thereafter of 51 years, taking into account that 69 is the average age at which a smoker dies. Data used in developing the ranking were collected from the U.S. Census Bureau, Bureau of Labor Statistics, Centers for Disease Control and Prevention, Insurance Information Institute, NYsmokefree.com, Federal Reserve Economic Data (FRED), Kaiser Family Foundation and the Independent Insurance Agents & Brokers of America.

In 2016, the American Lung Association gave Connecticut an “F” grade in its spending of tobacco prevention and control funds.  The ALA points out that 40 states and Washington D.C. spend less than half of what the Centers for Disease Control and Prevention recommends on their state tobacco prevention programs.  Overall, states spend less than two cents of every dollar they get from tobacco settlement payments and tobacco taxes to fight tobacco use.  Each day, more than 2,600 kids under 18 try their first cigarette and about 600 kids become new, regular smokers, according to nationwide data from ALA.

A report on Connecticut's spending on tobacco prevention just over a year ago found that the state was being outspent over 67 times by tobacco companies' marketing efforts - due in large part to the state spending only a small portion of tobacco settlement funds on anti-smoking efforts.

The report, “Broken Promises to our Children: A State-by-State Look at the 1998 State Tobacco Settlement 17 Years Later," said the state was spending $1.2 million in FY 2016 to fight tobacco use. That's compared to an estimated marketing investment of $80.4 million by tobacco companies in Connecticut that year. The national average shows a margin of 20.1 to 1.  At that time, Connecticut ranked 38th in spending on a percentage basis.  The state has consistently spend less than the CDC has recommended.

The annual report was developed by the Campaign for Tobacco-Free Kids (CTFK), a coalition that includes the American Heart Association, the American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation, Americans for Nonsmokers’ Rights, and the Truth Initiative.

A year later, the next report ranked Connecticut last, as Connecticut’s projected spending on smoke cessation and tobacco prevention efforts for FY 2017 dropped to zero.  The report found that 13.5 percent of adult state residents are smokers, and 10.3 percent of high school students smoke.  Just under 5,000 deaths each year are caused by smoking in Connecticut, and 27 percent of cancer deaths are attributable to smoking.  Connecticut’s cigarette excise tax, $3.90 per pack, is the second highest in the nation. It was estimated that the state would collect $519.7 million in revenue this year from the 1998 state tobacco settlement and tobacco taxes, but will spend none of it on tobacco prevention programs.