BISMARCK, N.D. – North Dakota's efforts are leading the nation to keep kids away from tobacco and help those that do smoke, quit. A national report lists North Dakota as one of only two states in the country that funds tobacco prevention and cessation programs at levels recommended by the Centers for Disease Control and Prevention.

Donna Thronson, the health communications coordinator with the North Dakota Center for Tobacco Prevention and Control Policy, known as "Breathe N-D," says they work with people at the local level.

"We fund local public health units across the state to do community intervention on tobacco prevention," she explained. "They go into schools, and build comprehensive tobacco-free policies. And our work is never done, because you know, with the introduction of e-cigarettes, they had to go in and update all the policies."

North Dakota will collect almost $67 million this year from the 1998 state Tobacco Master Settlement, and will spend almost 15 percent of the money on tobacco prevention programs.

While 15 percent may not sound like much, most states divert all their federal tobacco-settlement money for other purposes. Thronson says North Dakota plans to continue its investment in keeping people from becoming tobacco users.

"The rest of the payments that come in, to the tune of a half-billion dollars, are payments that will continue in perpetuity," she said. "So, these funds we have were never designated for anything but tobacco prevention."

Outgoing Gov. Jack Dalrymple had wanted to eliminate the Center for Tobacco Prevention and Control Policy and divert its funding, and it's unclear what Gov. Doug Burgum's plans are for the center. But Thronson warns that cutting spending would ramp up health care costs, significantly.

"If you want to address health-care costs, you can't do that without addressing the problem of tobacco," she added. "Because tobacco costs our state $326 million in health-care costs alone each year, and $56 million in Medicaid expenses."

North Dakota's top ranking is in a report released by the Campaign for Tobacco-Free Kids.


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Recent research shows approximately half of people who die by suicide had contact with a health care professional within the month prior to their death.

However, a recent study shows only 8% of hospitals are currently implementing all four recommended suicide prevention practices: safety planning, warm handoffs to outpatient care, patient follow-up and lethal means counseling.

Melissa Tolstyka, director of Behavioral Health Services for Trinity Health Ann Arbor, said a seamless transition from inpatient to outpatient care is critical. At Ann Arbor, she saw a 46% increase in compliance with comprehensive suicide risk assessments and patients discharged on the suicide care pathway now receive a safety plan, which she sees as progress.

"We continue to see a need for really robust programming," Tolstyka explained. "Not just within the behavioral health world, but in the medical world as well. Our organization really wanted to focus on bringing the behavioral health and the medical services together to enhance our safer suicide care practices for our patients."

The initiative is being piloted across various units at Trinity Hospitals in Ann Arbor and Grand Rapids including the emergency department, psychiatric medical and inpatient nursing units. If you or anyone you know is struggling or in crisis, help is available 24 hours a day, seven days a week, by calling or texting 988, the Suicide and Crisis Lifeline.

Casie Sultana, clinical nurse leader for Trinity Health Grand Rapids, prioritizes patient well-being, emphasizing support and improvement over solely managing risks within the facility.

"We want to be someplace that people feel welcome to come to who are dealing with suicide," Sultana emphasized. "You feel so alone. It's a very lonely journey and we want people to come seek help and feel welcomed when they do that."

Susan Burchardt, clinical services manager at Trinity Grand Rapids, advised other hospitals considering a similar program to learn from organizations already using it.

Support for this reporting was provided by The Pew Charitable Trusts.


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Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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Alabama is running out of time to tackle Medicaid expansion this legislative session.

More than 230 people gathered earlier this month with the group Alabama Arise, urging state lawmakers to prioritize the issue. Their message: Access to health care isn't just a matter of policy, it can be a matter of life and death.

Debbie Smith, Cover Alabama campaign director for Alabama Arise, said as the session winds down, the group will continue to echo the call for increased access to health coverage. She thinks it would not only save lives but revitalize communities across the state.

"Over 80% of our rural hospitals are operating in the red," Smith pointed out. "Not a great stat. About 19 rural hospitals are at immediate risk of closure, and those are the lifeblood of those communities. They're on life support."

Smith emphasized hospitals at financial risk also put their workforce at risk. Those who are against Medicaid expansion believe it is ultimately unaffordable for the state. However, Smith argued it could save the state nearly $400 million over the next six years. According to the Public Affairs Research Council of Alabama, those savings would be enough to cover the cost.

The council's study also showed Medicaid expansion would generate nearly $2 billion of economic growth. Beyond economic benefits, Smith pointed to the stark disparities in maternal and infant mortality rates in Alabama.

She stressed Medicaid expansion would do more than provide health care coverage during pregnancy or postpartum, it is about ensuring comprehensive coverage.

"We've been lucky enough to expand Medicaid coverage up to 12 months postpartum but we still need to figure out how to cover people before they even get pregnant," Smith asserted. "It's really important for people to have health coverage so they can address any kind of issues they might have, like if they have diabetes or high blood pressure that might affect their pregnancy in the future."

With limited time left in the legislative session, she noted one option could be Gov. Kay Ivey's executive authority to enact Medicaid expansion. Smith added using the power could be the simplest path forward, backed by the promise of additional funding from the American Rescue Plan.