MANCHESTER, Ky. — When smoking first swept the United States in the early decades of the 20th century, it took hold among the well-to-do. Cigarettes were high-society symbols of elegance and class, puffed by doctors and movie stars. By the 1960s, smoking had exploded, helped by the distribution of cigarettes to soldiers in World War II. Half of all men and a third of women smoked.

But as evidence of smoking’s deadly consequences has accumulated, the broad patterns of use by class have shifted: Smoking, the leading cause of preventable death in the country, is now increasingly a habit of the poor and the working class.

While previous data established that pattern, a new analysis of federal smoking data released on Monday shows that the disparity is increasing. The national smoking rate has declined steadily, but there is a deep geographic divide. In the affluent suburbs of Washington, only about one in 10 people smoke, according to the analysis, by the Institute for Health Metrics and Evaluation. But in impoverished places like this — Clay County, in eastern Kentucky — nearly four in 10 do.

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The average life span of people with the inherited disease is 42 years for men. Richard Mitchell’s doctors now say he may be the oldest patient who is currently living with the disease.

BY TRACY MILLER / NEW YORK DAILY NEWS

SATURDAY, MARCH 15, 2014, 10:20 PM

ALEC TABAK FOR NEW YORK DAILY NEWS

Doctors once told Richard Mitchell he wouldn’t live past age 40. This week, he blew out the candles on his 70th birthday cake.

Mitchell has sickle cell disease, an inherited blood disorder that used to kill people before age 20. Even with today’s medical advances, the average life expectancy in the U.S. is 42 years for men and 48 for women.

“You just take it one day at a time,” Mitchell said during a birthday party thrown for him Thursday at Mount Sinai Hospital.

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The elderly man lived alone in an apartment complex not far from the hospital. A younger neighbor, who’d watched him hobble down the building’s stairwell for nearly a week, insisted on taking him to the emergency room. Doctors there immediately diagnosed an infection in his painful toe and prescribed antibiotics for him to take at home.

But they also advised the man to be sure to take his diabetes medicine, since the infection could elevate his blood sugar to dangerous levels. And as the surgical consultant, I urged him to keep his foot up, check the toe once a day and come to our vascular surgery clinic in a week to make sure the infection was clearing up. He needed close follow-up to prevent serious complications, even the loss of his foot.

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In a little-noticed outcome of President Obama’s Affordable Care Act, jails and prisons around the country are beginning to sign up inmates for health insurance under the law, taking advantage of the expansion of Medicaid that allows states to extend coverage to single and childless adults — a major part of the prison population.

State and counties are enrolling inmates for two main reasons. Although Medicaid does not cover standard health care for inmates, it can pay for their hospital stays beyond 24 hours — meaning states can transfer millions of dollars of obligations to the federal government.

But the most important benefit of the program, corrections officials say, is that inmates who are enrolled in Medicaid while in jail or prison can have coverage after they get out. People coming out of jail or prison have disproportionately high rates of chronic diseases, especially mental illness and addictive disorders. Few, however, have insurance, and many would qualify for Medicaid under the income test for the program — 138 percent of the poverty line — in the 25 states that have elected to expand their programs.

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TAYLORSVILLE, Ky. — Dr. Sven Jonsson, a primary care physician in this rural community, is seeing a steady tide of new patients under President Obama’s health care law, the Affordable Care Act. And so far, it is working out for him. His employer, a big hospital system, provides expensive equipment, takes care of bureaucratic chores and has buffered him from the turmoil of his rapidly changing business.

“This is just a much saner place for me right now,” said Dr. Jonsson, 52, who left private practice to work for the system, Baptist Health, in 2012. “I’m probably going to live another five years.”

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The Shift Doctors (Marion Ross, Ph.D. and Tracy Latz, M.D.) have taught classes and seminars in personal transformation since 2002. They have come together to assist people with transforming anger/resentment, guilt/shame, disappointment/heartache, stress, fear/anxiety, lack of self-love, & grief/loss, and then reacquaint people with theirTrue Essence (who they really are)- which is essential to understanding what holds each of us back and causes us to feel stuck in our lives, circumstances, relationships and career paths. They also teach courses in Reiki, Color and Sound Healing, Energy Psychology, Energy Medicine, Meditation and other Metaphysical Topics.

How To Find Your Passion/ Purpose

Wouldn’t you just love to jump out of bed every morning filled with fire and enthusiasm for something? Perhaps you have been searching for that something for years or have just settled for a more mundane life out of not knowing any better way. Perhaps you feel that you have too many responsibilities to change course, or that you don’t deserve anything greater or have a fear of the unknown. Finding & Following your passion can be a difficult journey but consider it a journey not an instant revelation

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