Tennessee Thrive 2015

THRIVE
LIVING WELL IN TENNESSEE
ITS NEVER TOO

LATE TO QUIT
Find the help you need to kick

the smoking habit for good
HIT THE
TRAILS
Tennessee State Parks offer easy

(and free!) ways to stay active
2015 SPONSORED BY THE TENNESSEE DEPARTMENT OF HEALTH
HEALTH IS HAPPINESS
INSIDE
46
9
GOVERNORS LETTER
14
24
Hit the Trails
Eat, Play, Sleep

Studies show children need
a healthy start to become
healthy adults.
10
HEALTH BRIEFS
55
HEALTH DEPARTMENT
NEWS
Tennessee State Parks offer easy

(and free!) ways to stay active.
56
BE WELL
18
The Flu
a Preventable
Illness
Protect yourself with an annual
vaccine to avoid getting sick.
28
Safe and Snug
Following Safe Sleep guidelines
will ensure that your baby is
resting comfortably and safely.
Thrive: Living Well in Tennessee I 5
ON THE COVER
Hope Ross and her children enjoy being active at
Panther Creek State Park in Morristown.
Photo by Brian McCord
38
32
32
42
50
Fitness
Can Be Fun
Be Prepared
Its Never Too

Late To Quit
From walking to yoga, its easy to

make fitness a part of your life.
38
Say Cheese!
The Tennessee Department
of Health gives families plenty
of reasons to smile.
Tips to help keep your family

safe and sound when theres
an emergency.
46
Improving Your
Health One Step
at a Time
Healthier Tennessees Small Starts
program can mean big gains in
health, not weight.
Find the help you need to kick

the habit for good.
52
Anytime.
Anywhere.
Anyone.
Traumatic brain injury affects
more than 2 million Americans.
LIVING WELL IN
TENNESSEE
elcome to the inaugural issue of Thrive, an annual magazine created

by the Tennessee Department of Health and Tennessee-based
publisher Journal Communications Inc. We hope you will find the
stories, photographs and information compelling, and that it will
inspire you to be healthier.
Few things affect our quality of life and prosperity as much as our own health and the
health of others in our circle of family and friends. Across Tennessee, there are many
opportunities to savor home-grown nutritious food, to exercise in beautiful parks and
nature areas, and to relieve stress by enjoying the music and culture around us.
In the summer of 2013, we launched Healthier Tennessee, a statewide initiative to
encourage Tennesseans to be more physically active, to eat healthier foods in healthy
portions and to not use tobacco products. Thrive will complement this effort, providing
information to help more Tennesseans live well in Tennessee.
Sincerely,
Bill Haslam
Governor
hen we started discussing a magazine about living well in Tennessee,

it reminded us how fortunate we are to live in such a great state. Local
farmers produce an amazing array of healthy foods to nourish us.
Beautiful lakes, hills, paths and parks provide opportunities for fun
and exercise. Some of the worlds best music and arts stimulate our brain.
We recognized some may not be aware of local resources to help them on their paths
to better health. This publication will provide information about whats available
across Tennessee and what individuals and families can do to live life to the fullest.
We also hope it will advance the Tennessee Department of Healths mission to
protect, promote and improve the health and prosperity of people in Tennessee and
to help us achieve our vision of being among the top 10 healthiest states in the nation.
Life is precious. Take advantage of what Tennessee has to offer to make you stronger,
fitter and happier every day as you continue on your personal journey!
Sincerely,
John Dreyzehner, MD, MPH, FACOEM

Commissioner
Tennessee Department of Health
HEALTH BRIEFS
THRIVE IN
TENNESSEE
ONLINE HELP
WEBSITE HAS
A VARIETY OF
RESOURCES
FOR PARENTS
arenting. Its one of the

most rewarding, but also
challenging, parts of life for
many. In Tennessee, parents,
grandparents and others can find
answers to questions and access
important services and resources
through an informative website:
kidcentraltn.com.
Because the kidcentraltn.com website
information is sorted into categories
health, education, development and
general support parents can quickly
and easily find what they need for
their children to be healthy, happy
and successful in life. The website
was created by the Governors
Childrens Cabinet, co-chaired by
Gov. Bill Haslam and First Lady
Crissy Haslam.
The website has a My Profile
section, allowing families to have
a more personal experience and to
tag articles important to their unique
needs and situations. Parents can
receive recommendations for articles
and services that might fit their
family and periodic emails about
new programs and initiatives to
help families.
A free kidcentral tn mobile app is
also available for families to receive
updates, search hundreds of state
services and even store their childs
emergency contacts and school/
child-care information. There is also
a kidcentral tn Facebook page and
Twitter account. The website is also
a valuable resource for doctors,
case managers, teachers, child-care
providers, librarians and
other professionals.
HEALTH BRIEFS
PRETEEN VACCINES
PREVENTING CANCER
AND OTHER DISEASES
30%
FEWER THAN 30 PERCENT

OF YOUNG TEEN GIRLS
IN TENNESSEE ARE
PROTECTED AGAINST
HPV, AND THAT NUMBER
IS FAR LOWER FOR BOYS.
symptoms or treatment, certain strains can cause

persistent infections that can lead to cancer.
There are two vaccines that protect against the most
common cancer-causing types of HPV, Cervarix and
Gardasil. Because these vaccines cannot treat existing
infections, HPV vaccines are routinely recommended
along with other preteen vaccines given at age 11 or 12.
The CDC reports that fewer than 30 percent of young
teen girls in Tennessee are protected against HPV, and
Preteens and teens can be spared from many cancers and
that number is far lower for boys. Too many young men
other diseases later in life if they are vaccinated against
and women in Tennessee will go on to develop cancers
HPV. Human papillomavirus, known as HPV, is one of the
and other HPV-related diseases that could have been
most commonly transmitted viruses in the United States.
prevented by this safe and highly effective vaccine.
It is the cause of many cancers including cervical, vulvar,

vaginal, penile, anal, and neck and throat cancers. It can
also cause genital and respiratory tract warts.
The HPV vaccine is covered by insurance plans and is

available to all teens under the age of 19 who do not have
insurance coverage for HPV vaccine through the federal
The Centers for Disease Control and Prevention reports
Vaccines for Children program. For more information
79 million Americans have HPV and 14 million more become
about VFC, ask your health-care provider or local health
infected each year. While most infections clear up without
department, or visit www.cdc.gov/hpv.
HEALTHY ANIMALS
PETS VS. PARASITES
FARMS AT YOUR FINGERTIPS
AN APP A DAY
A Pick Tennessee Products promotion

has plowed forward for nearly 30
years, connecting customers to
locally grown products and farmrelated activities. Now, a Pick
Tennessee mobile app is available
with information on local farms,
produce and farmers markets.
The free app has GPS mapping and
is downloadable from both iTunes
and Google Play.
Parasites can be a problem for pets like dogs and cats, so the Tennessee
Department of Health advises owners to bring their pets to a veterinarian
for annual checkups. At that time, veterinarians will check for parasites.
Pets might not be sick, but they might be parasite carriers that could lead
to human illnesses, especially in households with young children, says Dr.
John Dunn, deputy state epidemiologist with the Tennessee Department
of Health.
Dunn adds that for people who raise chickens or baby ducks, it is vital to wash
your hands after handling the animals to prevent the spread of salmonella.
More healthy pets/healthy people tips are at cdc.gov/healthypets.
12 I Thrive: Living Well in Tennessee
We now reach consumers where

they already expect to find us
on their phones and other digital
devices, Tennessee Department of
Agriculture Commissioner Julius
Johnson said in a press release.
The Pick Tennessee app allows users
to search by item, such as apples, by
region of the state or season, then
provides GPS directions.
NUTRITION FOR NEWBORNS
MOTHERS MILK
Breast-feed? Yes, mothers
should definitely breast-feed
their babies.
That recommendation is
from Tennessee Department
of Health physicians who say
mothers milk should be the
only food given to a baby for
at least the first six months
of an infants life.
ONLINE RESOURCE
ONE FOR ALL

One Health is a new program that
encourages Tennessee physicians,
veterinarians, environmental scientists
and public health officials to better
communicate and collaborate with
one another. Why? For the combined
safety and health of people, animals
and the environment.
Breast milk provides all

the nutrition babies need
during those first six months.
They dont need anything else,
says Dr. Michael Warren, the
director of Family Health
and Wellness for the
Tennessee Department
of Health.
One Health advocates a holistic

approach because humans, animals
and the environment are all linked
together. The initiative encourages
Tennessee health professionals to
touch base whenever a potential
breakthrough is discovered as they
tackle challenges such as emerging
infectious diseases, antibiotic
resistance and preparedness
for major emergencies.
Studies show that breastfeeding can also help decrease

later health problems for
women, including diabetes,
obesity, ovarian and breast
cancers, cardiovascular issues
and calcium depletion. For the
babies, breast-feeding helps
decrease early instances of
diarrhea, ear infections and
pneumonia.
Regular meetings take place, and all

professionals are welcome to attend.
More information is at health.state.
tn.us/ceds/onehealth.
OUTDOOR PROTECTION
BITING BACK
Want to take the bite out of mosquitoes and ticks? Use repellent. Thats the
best protection against serious diseases and viruses carried by these insects.
Tennessee has two main viruses that can be transmitted to humans by
mosquitoes. One is perhaps the best known West Nile virus, which began
affecting Tennesseans in 2002. Another is La Crosse virus, found mostly in
East Tennessee in rural Appalachian areas. A third virus called chikungunya,
or CHIK virus, has recently been transmitted to several travelers returning
from the Caribbean, especially from Haiti.
In addition to those pesky mosquitoes, ticks can carry more than a dozen
different diseases. There are no vaccines for any of these viruses, so certainly
use repellent whenever youre in areas where mosquitoes and ticks might be,
says Dr. Abelardo Moncayo, Tennessee state medical entomologist.
FITNESS
HIT THE
TRAILS
TENNESSEE STATE PARKS OFFER EASY
(AND FREE!) WAYS TO STAY ACTIVE
By Reed Galin
ometimes Hope Ross brings her children

to Panther Creek State Park in Morristown.
They hike the 17 different trails, canoe across
Cherokee Lake, swim in the pool or splash in
the creek.
Sometimes she chaperones a pack of Cub Scouts.
And sometimes, like today, Ross is alone on a shady
trail deep in quiet woods, exercising, thinking, praying.
What I notice most about being here is tranquility,
Ross says. Its nature as God intended it with trails
cut through so I can safely observe the peace, feel
my muscles working and appreciate that Im able.
Ross, 36, is not an exercise nut but is consciously
active because, she says, her family depends on her.
When Im here with the kids, she laughs, there is no
line between exercise and recreation. But as a mother
and wife who works two jobs, I have to think about
my health.
IMPROVE PHYSICAL
AND MENTAL HEALTH
A few years ago, needing time alone to process

personal challenges, Ross began to utilize Panther
Creek. It is one of 54 Tennessee State Parks and 82
State Natural Areas from the Great Smoky Mountains
National Park to the Mississippi River, spanning every
kind of natural environment that exists in this state.
Some parks also have restaurants and golf courses.
Almost all preserve large expanses of natural
landscapes through which there are more than 1,000
miles of trails easy and strenuous for walkers and
runners, mountain bikers and horse riders. Most state
parks have the broad range of recreational and natural
resources that Ross enjoys at Panther Creek. She says
spending time there every few days, with and without
her children, has noticeably improved her physical
fitness and mental health.
MORRISTOWNS PANTHER CREEK STATE

PARK IS A GREAT PLACE TO BE ACTIVE.
In fact, medical research consistently finds that even

mild exercise like walking improves cognitive function,
depression and stress response. In early 2014,
University of Pittsburgh researchers reported that
elderly people walking three times a week for a year
increased the size of brain areas linked to planning
and memory. A few months later, a Stanford University
study titled Give Your Ideas Some Legs found creative
brain function demonstrated by walkers was 60
percent higher than for people who just sat.
TAKE IT OUTSIDE
Some studies indicate that people who exercise

outdoors are more likely to stick with it. Seventy-yearold physician John Phillips says that is certainly the
case for him. As a doctor, Phillips often advises his
patients to figure out something they can do with
family members, a walk they might take for 20 minutes
to start with, three times a week and gradually
RADNOR LAKE STATE NATURAL AREA IN NASHVILLE OFFERS 1,200

ACRES OF WOODED LANDSCAPE THAT MAKES IT EASY TO ENJOY
THE GREAT OUTDOORS WITH YOUR FAMILY.
doubling that level of activity over time. He even

has a particular favorite place in mind and takes
his own advice.
Phillips rhythmically taps a smoothly worn walking
stick on the trail as he strolls along the water at Radnor
Lake State Natural Area, 1,200 acres of wooded landscape
that seems a world away from the 2 million people of
Greater Nashville that surround the park. On a warm
evening, as long orange shadows reach through still
trees, he walks alone, breathing deeply, perspiration
glistening on his forehead, working on a knee that
has given him some trouble. But Phillips exercises

with a smile on his face. This is not just work, its
something I enjoy, its natural, it could be a thousand
years ago. The way the park is managed, this is how
it used to be. I think about being an Indian walking
through the forest 1,000 years ago.
The last time Phillips came here was with his
grandchildren. They counted 30 different animals on
the 2-mile trail. If his regular walks werent helping
control his blood pressure and weight, he says, he
might not even be having such fulfilling experiences.
Phillips adds a final thought about why he has enjoyed
Radnor and the other state parks he has visited. The
people you encounter are usually happy people.
An observation confirmed by medical research.
FOR MORE INFORMATION ABOUT TN STATE PARKS,

GO TO TNSTATEPARKS.COM/ACTIVITIES/HIKING.
DISEASES & CONDITIONS
THE
FLU
A SERIOUS,
PREVENTABLE
ILLNESS
PROTECT YOURSELF WITH A

VACCINE TO AVOID GETTING SICK
By Susan Quick
nfluenza the flu is not a severe cold. It is a

deadly illness that claims the lives of young and
old alike. Sadly, many of these flu deaths and flu
cases are preventable, thanks to vaccines readily
available across Tennessee.
According to Dr. Kelly Moore, M.D., director of the
Tennessee Immunization Program, safe and effective
immunizations have been shown to prevent millions
of flu cases in a single season. She says annual doses
of vaccine are important because the protection is
not permanent and declines over the year.
Flu seasons vary from year to year but generally
start in October and continue through April or as late
as May, usually peaking in January and February here
in Tennessee, Moore says. Even if you received the
vaccine last season, you need it each and every season
to be fully protected. There are many options available,
including traditional injections; egg-free vaccine,
especially helpful for those with severe egg allergies;
nasal spray vaccine; and one with a tiny needle that
goes just under the skin.
The nasal spray vaccine is an option for most people
age 2 through 49. It works as well as the shot in older
children and adults but is now preferred by experts
for children 2 through 8 because studies have shown
it to be somewhat more effective than the shot for that
age group.
Women who are pregnant, children under 2, and
those with asthma and other chronic diseases or
compromised immune systems should still get the
shot. With all of the options available, it is unlikely
any one provider will have every kind. The Centers for
Disease Control and Prevention recommends you use
whatever is available at the time and appropriate for
your age and health status.
EVEN IF YOU
RECEIVED THE
VACCINE LAST
SEASON, YOU NEED
IT EACH AND EVERY
SEASON TO BE
FULLY PROTECTED.
All children should start getting flu vaccines to
protect them each flu season beginning at 6 months
of age. The very first season a young child gets the flu
vaccine, two doses are needed (given a month apart) to
help their young immune systems protect them. After
that, only one dose is needed each year. All adults and
children 9 years and up need only one dose.
VACCINES SAVE LIVES
The effectiveness of the flu vaccine varies from

season to season and from person to person, but it
is the very best protection we have. The bottom line
is that flu vaccine saves lives. It prevents frightening,
serious illness in people of all ages every year,
Moore says.
When each of us is immunized, it helps us stay
healthy, she continues. When we are healthy, we help
prevent harm coming to vulnerable infants, pregnant
women, the elderly our friends and loved ones. And

dont put off your vaccination; it takes up to two weeks
to get the full benefit of the vaccines protection.
After vaccination, most people will have temporary
soreness and redness at the injection site. Some may
feel under the weather for a day or so as their body
responds to the vaccine. It is rare that someone
cannot be vaccinated; people with questions should
talk to their health-care provider. Flu shots are one
of the great medical developments in history, saving
lives and preventing much unnecessary pain
and suffering.
FLU FACTS
Moore recognizes there are many falsehoods

and rumors that circulate about the flu vaccine.
She points out it cannot give you the flu.
It is true that vaccinated people may still get the

flu or a flu-like illness, Moore says. Some of these
actually have one of the many other, less serious winter
viruses that the flu vaccine does not prevent. People
who delay getting the vaccine may also actually be
exposed to the flu before the vaccine can protect them,
and some who are vaccinated go on to catch the flu
anyway, but their illness is likely to be less serious
than it would have been without the vaccine. What we
know for certain is that people who are unvaccinated
are always at a higher risk of catching the flu than
people who are vaccinated.
To boost access to the flu vaccine, public health
departments and large clinics across the state are
offering no-cost or low co-pay vaccines for those who
qualify, whether they have health insurance or not.
The federal Vaccines for Children program provides
FIVE STEPS TO
TAKE IF YOU GET
THE FLU
No one likes to be sick. Thats why getting a flu
shot is your best prevention. But, if you do come
down with the flu, here are some tips to help you
feel better.
Stay at home and rest.
Avoid close contact with well people in

your house so you wont make them sick.
Drink plenty of water and other clear liquids

to prevent fluid loss (dehydration).
Treat fever and cough with medicines you

can buy at the store.
If you get very sick, are pregnant or are 65

years or older, or are otherwise at high risk
of flu-related complications, call your doctor.
You might need antiviral drugs to treat flu.
Source: Centers for Disease Control and Prevention
free vaccines through about 650 participating private

and public clinics statewide to eligible children and
teens under 19 years of age. VFC vaccines are given
for a small administration fee that can be adjusted
if needed.
Moore says about half of Tennessee children
are eligible for VFC because they are uninsured,
on TennCare or lack insurance coverage for vaccines.
Vaccines may be provided in some Tennessee schools.
Parents of young children may find this a convenient
option. The vaccine is also available at pharmacies,
local health clinics and at your doctors office.
FOR MORE INFORMATION VISIT

HEALTH.STATE.TN.US/FLU.
WASH HANDS, RINSE, REPEAT

The cornerstone of flu prevention is receiving
the flu vaccine, says Dr. Kelly Moore, director of
the Tennessee Immunization Program. There are
other respiratory viruses circulating during flu
season, and you can still get one of these despite
having your flu shot.
Its important to remember that germs are
everywhere and can linger as long as eight hours
on things such as door handles, grocery store carts,
checkout aisle pens and the numerical pads at ATMs.
Here are the top stay-healthy tips recommended
by the CDC:
First and foremost, wash your hands frequently
throughout the day and thoroughly. Lather up with
running water and soap, and scrub your palms,
fingers and backs of your hands for 20 to 30 seconds.
If washing your hands isnt convenient, you can use
hand sanitizer with at least 60 percent alcohol, says
the Centers for Disease Control and Prevention.
Cover your mouth and nose when you cough or
sneeze. Coughing and sneezing can project the virus
up to 6 feet.
Stay at home when you are sick rather than going
to work.
Getting Healthier Doesnt Have To Be Hard.

Thats why we created Small Starts,
a series of simple activities to help you:
EAT HEALTHIER
MOVE MORE
CUT OUT TOBACCO
Eating better increases

your energy and helps
Exercising helps you reduce

stress, maintain a healthy
you control your weight.
weight and feel better.
Living a tobacco-free lifestyle

reduces the risk of disease
and saves you money.
Available at healthierTN.com.
Now its even easier to get started on the path to healthy living.
Our new iOS app helps you get started, create a streak
of success and stay motivated.
Small Starts tools for workplaces and faith
communities are also available.
FAMILY HEALTH
EAT
PLAY
SLEEP
STUDIES SHOW CHILDREN NEED A HEALTHY

START TO BECOME HEALTHY ADULTS
By Teree Caruthers
hos the biggest

influence on
children when
it comes to their
health and fitness? According to a
study by the Academy of Nutrition
and Dietetics, parents have more
influence on their childrens
behavior than anyone else.
Parents even outrank sports
celebrities as the person the child
wants to be like most, says Joan M.
Cook, M.S., R.D., nutritionist for the
Division of Family Health and
Wellness. Children will follow
the lead of the adults they see
every day.
Cook says leading by example
and discussing the importance of
making healthy choices with

children can go a long way in
building a firm foundation for
healthy lifestyle choices
in adulthood.
Research shows a diet rich in
fruits and vegetables is associated
with a decreased risk of many
chronic diseases, including
cardiovascular disease, high blood
pressure, stroke, diabetes and some
cancers, and can play an important
role in weight loss.
FIRST LADY REACHES

OUT TO CHILDREN
Thats why Tennessee First Lady

Crissy Haslam created the Kitchen
and Cutting Garden at the governors
mansion in an effort to promote
FIRST LADY CRISSY HASLAM HOSTS STUDENTS FROM AREA SCHOOLS TO ENCOURAGE
HEALTHY EATING HABITS FOR CHILDREN AND THEIR FAMILIES.
FITNESS FAQs FOR KIDS & TEENS

SHOULD I EXERCISE EVEN WHEN IM TIRED?
Experts recommend healthykids and teensget at least60 minutes
of moderate to vigorousactivity eachday. Ifyou areworn out, its good
to rest for a day. In fact, taking a day off isrequired for certain types
of exercise like strength training. This helps the body repair itself and
protect itself from injury. Tiredness or aching in the muscles is the bodys
way of telling you it needs a break. If youre still feeling tired after taking
a few days off, talk to your health-care provider.
HOW CAN I STAY MOTIVATED TO EXERCISE

AND STAY ACTIVE?
The best way to stay motivated is to pick activities you enjoy doing!
Its also easier to stay in a routine if you write down a schedule for yourself
and stick with it. If you keep a list of the activities you do, you can look
back and see how well youve done. You can also sign up for a class or
join a team this provides you with a set schedule and people to stay
active with.
If you dont want to join a large group, you can still find a workout
buddy to exercise with. Even if you cant always work out together, you
can stay in contact and make sure each other is working hard. Vary the
activities you do to keep yourself from getting bored. Once you establish
a routine it will get easier to stick with it.
HOW CAN I LOSE WEIGHT IN A PARTICULAR

PART OF MY BODY?
The fact is, you cant really target where you are going to lose weight.
Cardio activities like running and biking, combined with a healthy diet,
are a good way to lose weight all over your body.
Other activities like crunches, push-ups, yoga and lunges may not
cause weight loss in specific areas, but they will target and tone certain
muscles. Well-toned muscles give your body a strong, fit look. Every body
is different, so if you think you need to lose weight, talk with your parents
and health-care provider about setting up a nutrition and activity plan
thats right for you.
Source: getfit.tn.gov/kids/faqs-fitness.aspx
the states agriculture industries

and to encourage healthy eating
habits among Tennessee children
and their families.
Haslam regularly hosts student
groups at the residence and invites
them to tour the cutting garden
and the residence kitchen, where
Chef Stephen Ward gives children
a farm-to-table cooking lesson
using vegetables and herbs from
the garden.
Visitors of all ages have loved
eating green beans fresh from
the Tennessee Residence Garden,
Haslam tweeted. Weve harvested
90 pounds this year!
Teachers, students and parents
can also download a Tennessee
Residence Garden Guide (tn.gov/
firstlady/files/Garden-Guide.
pdf) that includes fun facts about
Tennessee agriculture, a diagram of
the plant life cycle, and games and
puzzles designed to teach children
about fruits, vegetables and the
benefits of healthy eating.
PHYSICAL ACTIVITY
IS IMPORTANT
In addition to a healthy diet,

exercise also plays an important
role in a childs physical, social
and emotional development.
Developing good dietary and
exercise habits help children have
strong, healthy bones throughout
their lives, Cook says.
Activities such as jumping rope,
running, riding a bike or playing
tag help strengthen growing bones
and muscles, which is especially
important for children who havent
reached puberty. Studies show,
Cook says, that children who are
active also tend to eat healthier
and maintain good health into
adulthood.
THE KIDS ROCK MARATHON, PRESENTED BY THE YMCA, IS PART OF THE COUNTRY MUSIC MARATHON & 1/2 MARATHON.
HEALTHY LIVING
SAFE &SNUG
TENNESSEE DEPARTMENT OF
HEALTH ENCOURAGES PARENTS TO
FOLLOW SAFE SLEEP GUIDELINES
By Betsy Williams
t was Sandys second day of

being back at work in her West
Tennessee job after a very
satisfying 12-week maternity
leave during which she spent every
day with her new, healthy baby boy.
Everything from pregnancy to
delivery had been normal with
no complications.
But with one telephone call on
that June day in 2009, it all changed.
The baby sitter had asked on
the first day if the baby slept on his
back or stomach. She said that hers
had slept on their stomachs. I said
thats fine, Sandy remembers. I
dropped him off the first day, and
everything was good. On my
second day back at work, I got
a call at 11 oclock.
It was a call that every mother
lives in fear of receiving.
When she got to the hospital, she
learned baby Grant was dead, the
victim of a sleep-related death.
Babies grow up. I never

thought mine would get to be
12 weeks and that would be it for
me, Sandy says, still struggling
with painful memories of what
happened at the hospital and
afterward as she and her family
dealt with the loss of her son.
SLEEP-RELATED
DEATHS VS. SIDS
Unfortunately, similar stories

are repeated throughout Tennessee
because new parents and caregivers
may not be educated in the proper
infant sleep positioning and
environment. The state recorded
121 deaths caused by unsafe
sleep practices in 2012, or the
equivalent of five kindergarten
classrooms.
The Tennessee Department of
Health, through the Safe Sleep
program launched in 2012, is
working to change that.
Sleep-related deaths due to

suffocation and strangulation
are entirely preventable, says
Dr. Michael Warren, director of
the departments Division of
Family Health and Wellness. We
know why these babies die they
arent sleeping alone, they arent
sleeping on their backs, and they
arent sleeping in a crib or bassinet.
It is important to note the
distinction between sleep-related
deaths due to suffocation and
strangulation and SIDS, or Sudden
Infant Death Syndrome. Sleeprelated deaths due to suffocation
or strangulation occur because of
unsafe sleep practices, including
bed-sharing or having items such
as pillows, blankets and stuffed
animals in the crib. With sleeprelated deaths, a specific cause of
death can be identified, while SIDS
deaths remain a mystery, even after
investigation and autopsy.
BABIES SLEEP SAFELY ON THEIR BACKS

AND ALONE IN A CLEARED CRIB.
The ABCs of the Safe Sleep

campaign emphasize the need
for babies to sleep Alone, on their
Backs and in a cleared Crib.
RESOURCES
SLEEP BABY BOOK
This easy-to-read board book helps

educate parents about safe sleep
practices for their children.
RESOURCES
FOR PARENTS
Other risks can also come into

play in ensuring safe sleep.
An important risk factor to avoid
is infant exposure to cigarette smoke,
Warren says. Even thirdhand smoke
(residual nicotine and other chemicals
left on a variety of indoor surfaces
by tobacco smoke) can be risky for
an infant. We know from studies
that when babies are exposed to
cigarette smoke, there is an increase
in sleep-related deaths, he says.
Hospitals and health departments
throughout Tennessee are working
with the state Department of Health
in developing parent education
programs, handout materials
(including the Sleep Baby Safe and
Snug board book) and free mobile
phone apps, including Shelby
Countys B4BabyLife and
Baby2Sleep apps.
For Nashville mother Andrea

Champion and her sons Miller, 4,
and John Mills, 6 months the
Back to Sleep campaign is a
valuable tool that helped her and
husband, Sam, get off on the right
foot in establishing safe sleep
habits. The hospitals have new
parent orientation, and whether
you have one or five children, you
are required to go through it,
Champion says. They stress
the need to follow the ABCs
and provide plenty of material
to support it.
The Champions have also made
sure theyve created a calm and
loving environment for their two
little ones, resulting in long sleep
times and happy, rested children.
At school, Miller is a champion
napper, and both of my children
are easy to get to sleep for nap
and nighttime, she says. Sleep
is so important. If you miss the
optimum opportunity to put them
down for sleep, they become uber
tired and thats not fun
for anybody.
KNOW YOUR ABCs

The ABCs of healthy sleep
practices for infants begin with the
baby sleeping Alone, on the Back
and in a cleared Crib.
While it may be comforting to
have a baby sleep in the same bed
with parents, it isnt safe, cautions
Dr. Michael Warren of the Tennessee
Department of Health. Adults can
roll over onto the infant, causing
the baby to suffocate, he says.
We encourage room sharing,
not bed sharing.
When babies sleep on their
stomachs, they are prone to turning
their heads into the mattress or

blanket and cutting off the flow
of air, resulting in suffocation.
Statistics show that babies are
much more inclined to suffer from
a loss of air while sleeping on their
stomachs than from strangulation
that might occur while sleeping on
their backs. Pacifiers are encouraged
for sleep, as it offers the baby
comfort, although parents are
reminded not to force such use if

the baby isnt interested.
Finally, a safe crib environment
means healthy sleep for the baby. It
may seem cold, but it is best to
have the infant sleep on a firm
mattress in a crib that is void of
stuffed animals, bumper pads and
soft blankets. If the temperature is
cool, use a sleep sack for bedtime,
rather than wrapping her in blankets.
THE MAIN CONTRIBUTORS TO SLEEP-RELATED

DEATHS IN TENNESSEE ARE:
DEFINITION
INFANT MORTALITY RATE
The infant mortality rate is the
number of infant deaths per 1,000
live births. The infant mortality rate
in Tennessee has been declining
steadily over the past few years,
but it is still higher than the
national infant mortality rate.
83% 64% 48%
INFANT NOT
SLEEPING ON BACK
FACTS & STATS
SLEEP-RELATED DEATHS
Even though the overall infant mortality rate and number of infant deaths
have been declining over the past few years, there has been an increase in
the number of sleep-related deaths in the state. In 2012, 121 infant deaths
out of 576 were due to sleep-related causes. That means that 21% of all
infant deaths were due to sleep-related causes.
2011: National Rate

6 Deaths per 1,000 Births
INFANT SLEEPING
WITH OTHER PEOPLE
2011: Tennessee Rate

7.3 Deaths per 1,000 Births
BABY NOT SLEEPING IN

A CRIB OR BASSINETTE
Source: safesleep.tn.gov/datapage.shtml
FITNESS
FITNESS
CAN BE
FUN!
FROM WALKING TO YOGA, ITS EASY TO

MAKE FITNESS A PART OF YOUR LIFE
FACTS & STATS
GET MOVING
The American Heart Association recommends that adults get
150 minutes or more of moderate-intensity physical activity or 75
minutes of vigorous activity each week. Even short 10-minute activity
sessions can be added up over the week to reach this goal. If you
would benefit from lowering your blood pressure or cholesterol, aim
for 40-minute sessions of moderate to vigorous activity three to
four times a week. You could do this by walking 2 miles briskly
(about 4 mph). If thats too fast, choose a more comfortable pace.
NATIONAL
OBESITY
LEVELS
Source: American Heart Association
68.5%
OF ADULTS ARE
OVERWEIGHT OR OBESE;
34.9% ARE OBESE
By Reed Galin
ts early Saturday morning. The

YMCA in Franklin is humming
before you even get in the door.
Young and middle-aged adults
are on exercise bikes on the front
walk, vigorously peddling in sync.
Inside, 20 seniors are in the pool
smiling and talking with obvious
familiarity, so anxious to begin that
they bounce up and down in the
water like children until Wellness
Director Jenny Beadle starts her
Aqua Zumba class, leading
participants through a spirited
choreography of dance moves and
stretching.
The two workout groups typify
what Beadle says works best for
most people joining the YMCA.
People typically come in saying,
Im having trouble staying
accountable. I work out, fall off the
wagon and have to start all over.
Our key to success is getting them
into a community. The essence of
the Y is building relationships. If
that happens, weve seen that
theyre much more likely to keep
coming back.
FIND SOMETHING
YOU LIKE TO DO
YMCA counselors also help

develop individual programs for
members who dont prefer group
activities. But Beadle assumes that
people who really want to exercise
alone will more than likely join a
for-profit gym, where organized
workouts are not included in
membership fees like they are
at the Y.
Health measurements
nationwide have improved over a
decade with two notable
exceptions: excessive weight and
use of prescription antidepressants
(which has increased fourfold over
25 years).
This is not coincidental to Margie
Barr. After consulting with a trainer
at the Y, she joined an aerobics
class called Cardio Blast. Barr was
once an athlete, but now as a
48-year-old mother of four she
says, I was overweight and in
the worst shape ever. I was feeling
down and actually on depression
medication.
31.8%
OF CHILDREN AND ADOLESCENTS

ARE OVERWEIGHT OR OBESE;
16.9% ARE OBESE
30.4%
OF LOW-INCOME PRESCHOOLERS
ARE OVERWEIGHT OR OBESE
Disparities exist based on race-ethnicity,
gender, age, geographic region and
socioeconomic status.
Source: frac.org/initiatives/hunger-and-obesity/obesity-in-the-us
10.8%
32.6%
42.5%
47.8%
OBESITY
AFFECTS SOME
GROUPS MORE
THAN OTHERS:
Non-Hispanic blacks have
the highest age-adjusted
rates of obesity (47.8%)
followed by Hispanics
(42.5%), non-Hispanic
whites (32.6%), and nonHispanic Asians (10.8%).
OBESITY IS
HIGHER AMONG
MIDDLE-AGE
ADULTS,
40-59 YEARS OLD
(39.5%), THAN
AMONG YOUNGER
ADULTS, AGE 2039 (30.3%) OR
ADULTS OVER
60 (35.4%).
ADULT OBESITY FACTS
MEDICAL COSTS
The estimated annual medical cost of obesity
in the U.S. was $147 billion in 2008 U.S. dollars;
the medical costs for people who are obese were
$1,429 higher than those of normal weight.
Source: cdc.gov/obesity/data/adult.html
Barrs lifestyle had become

consistent with the 29 percent of
adult Tennesseans in a 2012 survey
who said they were not
participating in any physical
activity. Meanwhile, 21 percent
described their overall health as
only fair or poor, compared with
17 percent nationally.
With Tennessee below average in
some key health statistics, fitness is
being emphasized more and more
by county and local governments
from Sevierville, where aerobics and
volleyball are offered in a city-run
facility, to Dyersburg, where $15
buys a months membership at the
parks and recreation departments
activity center.
Experts say dissatisfied people
typically contemplate a change
for six months or more before
acting, and Barr was in that kind
of limbo. Finding time was an
issue. Motivation was an issue.
But she finally accepted the real
problem was her focus.
I finally just had enough
of feeling blah and being kind
of angry and down. It was just a
matter of finally turning a corner
and saying I just have to do it. After
two months, Barr says, she feels
that exercise is becoming a habit.
She has stopped taking her
depression medication.
ATTITUDE CAN
PLAY A ROLE
In fact, positive focus is the

critical element for most folks, says
University of Tennessee-Knoxville
Assistant Professor Becky Zakrajsek,
who is also the director of the
Applied Sport Psychology
Laboratory there. In working
with elite athletes to maximize
performance, Zakrajsek sees some
common principles that also apply
to ordinary people who succeed
in getting and staying in
better shape.
They focus on whats under

their control and on the process of
performing more than on outcome,
not on how much theyre sweating
or how far to the finish,
she explains.
And to succeed over time,
Zakrajsek says, as with athletes,
fitness must become part of who
you are, not just a prescribed
activity. Its putting as much
effort into attitude as it is physical
activity. Its the classic life lesson
the glass half full. Its easy to stay
on the couch. Its also easy to get up
off the couch.
That resonates with YMCA
trainer Beadle, who is dismayed
by a culture so sedentary and
used to physical convenience.
I see people in the lobby freak
out when they cant find the TV
remote. Even here, where people
come to exercise, I have to tell them
to just walk over and change
the channel!
HEALTHIER HABITS
Less than half, 48 percent, of all adults meet physical activity
guidelines of 150 minutes per week of moderate-intensity aerobic
activity. Food portions are approximately four times larger than 50 years
ago. Drive-through windows provide convenient unhealthy food choices.
Around-the-clock television programming and Internet access entice
many to sit for hours.
Is there any wonder why more than two-thirds of American adults are
overweight or obese and that a growing number of children are also
carrying too many pounds? While diet and activity may have changed
in recent decades, the simple math of human biology has not. Losing
a pound requires eliminating 3,500 calories
through diet and/or exercise.
Shedding extra weight can reduce the
risk for heart problems, stroke, kidney
disease and diabetes. It can also affect a
persons self-esteem, health-care costs,
employability and social interactions.
No matter how late in life a person
waits to cultivate healthier
habits, starting
today is still
better than
starting
tomorrow.
FAMILY HEALTH
SAY
CHEESE!
THE TENNESSEE DEPARTMENT OF
HEALTH GIVES FAMILIES PLENTY OF
REASONS TO SMILE
EXPERT TIP
GOOD ORAL HEALTH
AT EVERY AGE
Infants
Begin weaning babies from the
bottle at 12 months and avoid
prolonged use of pacifiers and
finger sucking, which can affect
oral development.
Use a teething ring, clean finger or
cold washcloth to provide comfort
to a teething babys sore gums.
After feedings, wipe your babys
teeth and gums with a clean, damp
cloth or gauze. And once the first
teeth appear, you can use a small,
soft-bristle toothbrush to clean
babys teeth.
1-5 Years Old

Brush your toddlers teeth with a
small, soft-bristle toothbrush at
least twice a day, using only a
pea-sized amount of toothpaste.
Floss between your childs teeth
that are in contact daily.
Make sure your child eats a
balanced diet, avoid sugary snacks
and sugary drinks.
Plan annual visits to the dentist
for cleaning and checkups.
6-Year-Olds to Adolescents
By Teree Caruthers
ne of the first things

people notice about
you is your smile.
Thats why its so
important to keep it healthy. But
unfortunately, fear and anxiety
and, in some cases, financial
burdens keep many people
out of the dentists chair.
People prioritize their healthcare needs, and medical care
always trumps dental, says
Oral Health Services Director
Suzanne Hayes, D.D.S. And one
of the biggest misconceptions
people have about dental care is
that everything is going to hurt.
Fortunately, there are remedies

for both problems. Thanks to
new technology and materials,
in addition to plastic sealants
that are applied to young teeth
to protect them from tooth decay,
a painful trip to the dentist is
more myth than reality.
CARE IS EASY TO FIND

The Tennessee Department of
Health offers many affordable
options for dental care from
routine exams to more
comprehensive procedures.
In Tennessee, there are many
Federally Qualified Health
Centers, which provide
Teach your child to brush his or

her own teeth and stress the
importance of brushing twice
a day and flossing daily.
Talk to your dentist or health-care
provider about applying sealants to
your childs teeth to help prevent
tooth decay.
Model healthy behavior by preparing
healthy meals with your child.
Plan annual visits to the dentist
for cleaning and checkups.
Teens and Adults

Avoid tobacco use, which can lead
to gum disease.
Brush your teeth at least twice a
day and floss between teeth daily.
Use a toothbrush that fits your
mouth comfortably, and consider
using an electric toothbrush, which
if used properly removes more
plaque than a manual toothbrush.
Replace your toothbrush every three
or four months.
comprehensive dental services

to adults and children. The
also provides comprehensive care
to children and emergency dental
care to adults at each of its clinics.
Fees for services are on a sliding
scale based on income.
Each year, the TDH travels
to qualifying elementary and
middle schools, community
settings and nonprofit
organizations, such as Boys and
Girls Clubs, to offer free dental
screenings, oral health education,
and application of sealants and
fluoride varnish to children in
grades K-8. In 2013, more than
17,000 children received oral
health screenings, referrals and
fluoride varnish applications at
TDH medical clinics.
Hayes says dental care is
especially important for children,
and she suggests children start
regular dental visits as early as
12 months old. She says parents
can begin using a soft-bristle
toothbrush to clean a babys

teeth as soon as the first
tooth appears.
A PREVENTABLE
PROBLEM
Oral diseases, such as tooth

decay, are among the most
prevalent health problems
of Tennessee children and
adolescents. In fact, studies show
that by age 8, more than half the
countrys kids have experienced
some amount of decay that if left
untreated can lead not only to
pain and other health problems
but also to poor appearance and
eventually low self-esteem.
The mouth is a part of the
body and, therefore, a problem
in one area will certainly show
elsewhere, Hayes says, adding
that individuals with diabetes
and pregnant women are at
greater risk for oral health
problems such as gum disease.
Oral health is not only
important to overall health but to
an individuals self-esteem, she

adds. Poor oral health can serve
as a barrier to employment and
goal attainment in life. One of
the first things people notice is
an individuals smile, so its
important that that is a positive
first impression.
Hayes says there are a few
simple steps parents can follow
to make sure their childrens
smiles stay healthy and bright.
For starters, Brush at least twice
a day, floss daily and eat a
nutritionally sound diet,
she says.
Kids and adults should also
visit a dentist or dental clinic
for a checkup and cleaning at
least once a year, and parents
should limit the amount of
sugary snacks, sugary drinks,
gum and candy children eat.
These foods can cause an
abundance of plaque a sticky,
colorless bacteria to build up
on the teeth, leading to cavities
and gum disease.
TONI HARRINGTON AND DR. PAUL MOELLER WORK WITH PATIENTS AT THE STATE DENTAL CLINIC IN FRANKLIN.
Good Oral Health
ne of the most
important steps to
maintain good dental
health also happens to
be one of the easiest. Drink more
tap water.
Thats because 89.7 percent
of the community water systems
in Tennessee contain the optimal
amounts of fluoride, an important
mineral that helps prevent tooth
decay. In fact, according to the
American Dental Association and
the Centers for Disease Control
and Prevention, fluoridated water
is the single most effective public
health measure to prevent tooth
decay, especially in communities
without regular access to
dental care.
Fluoride is natures cavity

fighter. It occurs naturally in water,
and community water fluoridation
is the adjustment of that level to
one proven to be safe and effective
in preventing decay.
Fluoride is also found in many
foods, such as spinach, carrots and
asparagus and, as we eat, fluoride
and other healthy minerals
accumulate in our saliva.
Water fluoridation helps ensure
that we take in enough fluoride
to continually bathe the teeth in
it each day and throughout life
to help prevent tooth decay.
Fluoride also makes your teeth
stronger and the surface of them
more resistant to acid erosion.
Even today, with other available
sources of fluoride, studies show

that water fluoridation reduces
tooth decay by about 25 percent
over a persons lifetime.
Besides water, other sources
of fluoride include toothpastes,
dietary supplements, mouth
rinses, and professionally applied
fluoride varnishes and gels.
As part of its school-based
oral health outreach program, the
offers at-risk children reduced or
free dental services, including the
application of a fluoride varnish to
the childs teeth to decrease the
risk of tooth decay later in life.
There is a correlation between
dental care early in life and the
condition of teeth in adulthood.
The dental services received by
children will impact their dental
and overall health for decades.
Connecting Communities Who Care
The Tennessee Primary Care Association and its member organizations

are committed to the well-being of all Tennesseans and to improving
access to quality health care. Our 34 member health centers operate
more than 200 clinic sites that provide comprehensive primary and
preventive care to individuals and families throughout the state.
To learn more about the Tennessee Primary Care Association
and to find a health center near you, visit us online at www.tnpca.org.
710 Spence Ln.

Nashville, TN 37217
615-329-3836
FAMILY HEALTH
BE
PREPARED
TIPS TO KEEP YOUR FAMILY
SAFE AND SOUND
By Teree Caruthers
usan McMahon Berry

and her husband, Dee,
consider themselves very
fortunate. Theyve never
been victims of the turbulent
weather that sometimes plagues
Tennessee. But if ever they are,
Berry has made sure theyll
be prepared.
We keep an emergency kit
prepared and in a safe place where
we can get to it easily and quickly,
says Berry, who lives in Nashville.
Weve got a case of bottled water,
a couple of flashlights and extra
batteries, canned goods, a manual
can opener, a few bags of dog food,
candles and matches, a first-aid kit
and a weather radio.
Jeremy Heidt, spokesman and
public information officer for the
Tennessee Emergency Management
Agency, says most people would be

surprised by the number of items
they already have in their homes
that can help them during
an emergency.
Theyre just not organized,
he says. The items are scattered
around the house. Your emergency
kit doesnt have to be fancy or
expensive just something to keep
you prepared, hydrated and fed.
Heidt says families can download
TEMAs free smartphone app,
ReadyTN, for a list of emergency
kit supplies.
Its a consistent list, so every
time you go to the store, you can
pick up one more item. Its not a
huge cost if you do it in a progressive
yet persistent manner. With that
list, for less than $100, you can get
everything you need, Heidt says.
OPERATIONS OFFICER RON MURRELL

MONITORS ACTIVITY AT TENNESSEE
EMERGENCY MANAGEMENT AGENCYS
OPERATION CENTER.
CREATE AN
EMERGENCY PLAN
TEMAs mission is the

preparedness, response, recovery
and mitigation of all hazards from
natural or man-made disasters and
emergencies, but preparedness is
everyones responsibility, Heidt
says. One of the most important
ways for communities to stay
prepared is for individuals
and families to create an
emergency plan.
First and foremost, know what
to do during an event whatever
it is, he says. If its a tornado, take
cover. If its a flood, stay out of the
water. Then make sure your family
has a rallying point in case youre
unable to make it home, and have
a plan to let somebody know where
you are.
A helpful tip is to designate an
out-of-town friend or relative as
the designated contact.
We know its best to call
somebody outside the immediate
area for two reasons, Heidt says.
One, that person is likely not
DOWNLOAD THE READYTN APP

The Tennessee Emergency Management Agency is the
911 for local government. During a declared state of
emergency, TEMA works directly for the governor as
the lead agency to coordinate response actions and
resources by all departments of state government.
The ReadyTN smartphone app gives residents
instant access to those resources. For example, the
app provides instructions on what to do during and
after an accident involving hazardous materials.
Hazardous materials are the No. 1 man-made
threat in Tennessee, says Jeremy Heidt, public information officer for
TEMA. Every day, there is an accident on the states highways involving
hazardous materials, which is why we conduct a lot of training of first
responders on how to handle these emergencies.
The ReadyTN app also has real-time information about road and
weather conditions, contacts for the states emergency shelters and
instructions on how to register with the Federal Emergency Management
Agency if Tennessee is affected by a declared national disaster.
[The app] also provides contact information for public safety offices
and elected officials for all 95 counties in Tennessee, as well as contacts
for state government via social media, Heidt says. If its an emergency,
dial 911. But if youve got a question about whats going on or what to
do in a certain situation, thats when you can reach back to your local
government. So its a lot of good information, and its right on your phone.
involved in whatever emergency is

happening. And two, its sometimes
a lot easier to make calls outside the
immediate affected area than it is
to make calls locally.
The website Ready.gov features a
family emergency plan individuals
can print out, complete and keep in
their purses or wallets. Parents can
also print out a plan with detailed
contact information for their
children that they can keep in
their backpacks and share with

a teacher or police officer in case
of an emergency. It includes the
familys emergency plan and where
the family should meet if they are
not able to get home.
Another important preparedness
measure is to know your neighbors
emergency plan.
If you have neighbors who are
elderly or disabled, they may need
to be checked on if the power goes
out, Heidt says, or you may have

neighbors on medication. If there
are prolonged periods where they
cant get out, do they have enough
medication to last them?
If youre ready and you can
check on your neighbors and
know that theyre ready and the
community is ready, then that
allows emergency personnel to
focus on the areas that have been
hardest hit.
Checklist for
Emergencies
BE INFORMED
Visit Ready.gov to download

templates for individual and
family emergency plans.
Learn your evacuation route
in case of inclement weather
or a natural disaster.
Know how youll be alerted if
there is a weather emergency
or hazardous materials spill.
Know the locations of your
nearest shelters.
MAKE A PLAN
Have a communications
strategy for accounting for
the whereabouts of family
members, such as calling
an out-of-town relative or
checking in on social media,

and agree on a meeting
location in case you are unable
to return home due to the
emergency or are separated.
Ask your employers and
your childrens school
administrators for the
emergency plans for work
and school.
BUILD A KIT
Ready.gov suggests including the

following in your emergency kit:
One gallon of water per person
per day for at least three days.
At least a three-day supply
of nonperishable food and a
manual can opener.
Flashlight and extra batteries.
A first-aid kit and enough

medication to last at least
three days and an extra pair
of prescription glasses.
A whistle to signal for help.
A dust mask, plastic sheeting
and duct tape to protect
from hazardous waste
contamination.
Local maps, a cell phone and
solar-powered charger.
A battery-powered or crankoperated
weather
radio.
FOOD & NUTRITION
IMPROVING
YOUR HEALTH
ONE STEP AT A TIME
SMALL STARTS CAN MEAN BIG
GAINS IN HEALTH, NOT WEIGHT
By Betsy Williams
ungry? Reach for

an apple.
Every journey begins
with that first step.
Thats the healthy eating advice
of Julius Johnson, commissioner
of the Tennessee Department of
Agriculture, who has shed more
than 50 pounds since joining the
Healthier Tennessee movement
in 2013.
I believe getting on a program
helps keep you accountable,
Johnson says. Today, theres a
conscious attitude about better
health in our department, in our
state and across the country.
STATEWIDE
INITIATIVE UNDERWAY
Johnson is one of more than
42,000 Tennesseans across the state
participating in Gov. Bill Haslams
Healthier Tennessee Initiative. The
Governors Foundation for Health
and Wellness, working with the
Tennessee Department of Health,

developed the Small Starts program
for individuals and businesses to
promote better health and
healthier lifestyles across the state.
We launched Small Starts
because changing your day a little
can eventually lead to changing
your life a lot, says Rick Johnson,
foundation president and CEO.
We advocate for three primary
behavior changes: Become more
physically active with at least 30
minutes a day of exercise; eat
healthier foods in the right portions
with more fruits and vegetables
and less sugar; and dont
use tobacco.
The mission is to encourage and
enable more Tennesseans to lead
healthier lives and lift Tennessee
out of the bottom 10 of the nations
health rankings, Rick Johnson
explains. Our estimates are that we
are spending at least $6 billion in
Tennessee in direct costs related to
Tennessee Nurses Foundation

SALUTES Advanced Practice
Registered Nurses
www.tnaonline.org
as Primary
Care Providers.
EXPERT TIP
HEALTHY EATING IDEAS
Your weight will stay the same when
the calories you eat and drink equal
the calories you burn. Try these ideas
to help you eat healthier.
Increase your vegetable intake
Replace sugary drinks with healthy
options like water
Keep fresh fruit handy and available
Keep serving sizes healthy and
reasonable
Substitute whole grain products for
your refined flour favorites
Source: Healthier Tennessee Small Starts
treating and dealing with behaviorbased chronic diseases, and that

doesnt include indirect costs of
absenteeism and productivity,
he says.
Despite more than 50 years
of proof that it is a leading cause
of health problems and death,
smoking remains a common
habit, with more than one in
four Tennesseans still hooked on
nicotine. And this doesnt include
smokeless tobacco products, which
have gained a national foothold,
especially among young people.
The role that obesity plays
in hypertension and stroke,
The challenge is how to change

those health-related behaviors.
The foundation is the nonprofit
corporation that is leading the
initiative of Healthier Tennessee,
and the call to action is Start Now.
MAKING HEALTHY
CHOICES
Small Starts provides participants

with daily tools and goals,
including selecting just one small
thing to change each day, whether
it is eliminating high-calorie sugar
drinks, eating a healthy pre-meal
snack to stave off hunger or
choosing 30 minutes of exercise
I BELIEVE GETTING ON
A PROGRAM HELPS KEEP
YOU ACCOUNTABLE.
Type 2 diabetes, heart disease and
several types of cancer hasnt been
documented for as many years as
tobacco use, but experts say that
the clinical research is indisputable.
The majority of people
understand the link between eating
unhealthy foods in large portions,
lack of exercise and what that does
to their health, Rick Johnson says.
instead of watching television.

And then, its important to keep
track of diet and exercise to better
incorporate those changes into
healthy habits.
The foundation has expanded
the Small Starts program to
workplaces and religious
organizations, providing
employers and faith-based
groups with tips, ideas and

actions to help participants
get healthier together. Walking
meetings, competitive goals and
a centralized point of information
are just some of the helpful tools
that will improve health outcomes
and reduce the cost of doing
business or operating
an organization.
According to the Tennessee
Department of Health, studies
show that employers save an
average of $6 for every $1 spent
on wellness.
When launching his initiative in
2013, Haslam asked his department
heads to lead the charge by serving
as healthy examples to their
respective departments. Julius
Johnson accepted the challenge.
I looked at myself and decided I
wasnt in any shape to lead anybody
when it comes to a healthier
lifestyle, he recalls. I call it
the Tennessee Creeping Crud
diabetes, obesity and high blood
pressure. We have to change our
attitude making the right choices,
leading an active lifestyle, looking
at our priorities and how we are
spending our money.
Thats where the apple comes
in, Commissioner Johnson says.
When faced with temptation,
dont give in; grab an apple
and make it a good one!
HEALTHY LIVING
ITS
NEVER
TOO LATE TO QUIT
FIND THE HELP YOU

NEED TO KICK THE
HABIT FOR GOOD
By Laura Hill
f you are a smoker or a former smoker, you know

all about getting winded going up stairs, greeting
the morning with a hacking cough, catching
those disapproving looks from co-workers.
Maybe youve driven out for cigarettes in the
middle of the night. Poked in ashtrays for a usable
smoke. Burned a hole in your favorite sweater. Or
couch. Maybe your doctor has lectured you. Maybe
your kids beg you to quit.
So if you smoke, maybe its time you stopped.
Sure, its hard. But you dont have to go it alone.
Help is close at hand, easy to access and free all
across Tennessee.
Its never too late to quit, says Bruce Behringer,
deputy commissioner for continuous improvement
and training for the Tennessee Department of
Health, whose own mother quit smoking at the age
of 60 after 46 years of lighting up and breathed
on until age 93. The physical harm from smoking
is continuously additive, so every cigarette adds an
assault on your cardiovascular system, making

the heart work harder.
SMOKING-RELATED ILLNESSES
Behringer points out some startling facts. Roughly

one in four adults in Tennessee smoke much
higher than the national average, and one out of
five children smoke, he says.
While most people understand that smoking is
directly related to lung cancer, and that other forms
of tobacco use, like smokeless tobacco, cause oral
and throat cancers, the list of illnesses and health
problems directly related to tobacco use may be
a surprise.
Research has found 16 different diseases and
conditions related to tobacco use, Behringer
says, among them strokes, diabetes, rheumatoid
arthritis, immune function, hip fractures,
pneumonia, cardiovascular disease, age-related
macular degeneration (eye deterioration), and as I
like to point out to adults, male erectile dysfunction
is causally linked to smoking. Smoking is now also
proven to be a cause of 11 different cancers beyond
lung cancer, he adds.
In Tennessee, he says, things are not going well,
as our state ranks close to the bottom among the 50
states for adult smoking; 47th in infant mortality
directly related to mothers smoking; 45th in cancer
deaths; 44th in cardiovascular deaths; and 43rd in
premature death.
COMMUNITIES TAKE ACTION
Fortunately, preventing these problems is

being addressed by the state and local communities,
which are spending $15 million over three years in a
three-part effort to encourage women to not smoke
during pregnancy; to reduce childrens exposure
to secondhand smoke, a major factor in asthma
attacks; and to combat tobacco use by children.
The funding comes from payments made to states
by tobacco manufacturers as part the national
tobacco settlement lawsuit.
Bedford County, for example, is using its $36,000
in funding to help limit the amount of secondhand
smoke that reaches preschoolers. And in 2014,
Knox County is working to help pregnant women
quit smoking, with outreach to local obstetricians,
monthly carbon monoxide screenings (increased
maternal carbon monoxide means less oxygen
for babies) and even baby showers for expectant
mothers who are trying to quit, says Kathryn
Burklund, public health educator with the
Knox County Health Department.
JUST SAY NO
Quitting tobacco has immediate advantages.

Within 20 minutes of giving up tobacco, elevated
blood pressure and pulse decrease; in two days,
nerve endings regenerate; in two weeks, circulation
improves; and in one to nine months, fatigue and
shortness of breath decrease.
The U.S. surgeon general reports that your risk
for a heart attack drops dramatically just one year
after you quit, and after two to five years, your
chances of having a stroke are about the same
as a nonsmokers. When you do quit, youre also
protecting the health of those around you who
risk disease and death from secondhand smoke.
Talk to your doctor about nicotine replacement
or other medication. Tennessees Tobacco Quit Line,
which is free to state residents, is a program with a
confidential telephone number (800-784-8669) and
website (tnquitline.org), where smokers receive a
quit kit and are assigned a personal quit coach to
help them for as long as a year free of charge.
Consider two last facts from the surgeon
general. Lifetime smokers live about 10 years
less than non-smokers. And more than half of
all adults who ever smoked have quit. And that
means you can, too.
10,000
ADULTS IN TENNESSEE WHO DIE EACH

YEAR FROM THEIR OWN SMOKING
15.4%
HIGH SCHOOL STUDENTS
WHO SMOKE
5,700 KIDS
(UNDER 18) WHO
BECOME NEW
DAILY SMOKERS
EACH YEAR
FINANCIAL FACTS
SMOKINGRELATED COSTS
Annual health-care costs in Tennessee directly caused

by smoking were $2.67B. $680M was covered by
Medicaid. Residents state and federal tax burden
from smoking-caused government expenditures was
$597 per household. Smoking-caused productivity
losses in Tennessee reached $2.96B.
125,000 KIDS NOW

UNDER 18 AND ALIVE
IN TENNESSEE,
WILL ULTIMATELY
DIE PREMATURELY
FROM SMOKING.
Source: tobaccofreekids.org/facts_issues/toll_us/tennessee
FAMILY HEALTH
ANYTIME. ANYWHERE.
ANYONE
TRAUMATIC BRAIN INJURY AFFECTS

MORE THAN 2 MILLION AMERICANS
By Susan Quick
lipping in the bathroom,

falling off a skateboard
or driving without a seat
belt. Traumatic brain
injury can happen when you least
expect it.
Just ask Pam Bryan. Eighteen
years ago, she received a call saying,
Theres been an accident
John Bryan was a popular,
well-rounded student attending
an academic magnet school in
Nashville in 1995. It was to be the
last carpool of the school year for
John, who would start wrestling
practice the following day. As he
climbed in the back of the minivan
driven by a friends mother, John
sat in the middle of the rear seat
the only one that had a lap seat
belt instead of a shoulder-lap belt.
That small choice of where to sit
nearly cost John his life.
On the way home, the driver
accidentally swerved off the road,
colliding with a utility pole. John
had the severest injuries of all. The
lap belt may have saved his life, but
it caused serious abdominal
injuries and damaged his spinal
cord, leaving him a paraplegic with

severe brain damage.
We never think this is going to
happen to us, Pam recalls. But it
can happen and in one split
second. My son was injured less
than a mile from our house.
After I got to the hospital and they
told me he had a traumatic brain
injury, I had not heard of it at that
time, she says. Given everything
that was wrong with him, I really
thought that his being in a coma was
the least of our worries, that he
would eventually wake up and still
be the same 13-year-old I said
goodbye to that morning.
But her sons traumatic brain
injury was significant. In addition
to multiple surgeries and many
months of recovery at Vanderbilt
Stallworth Rehabilitation Hospital,
John would require specialized
rehabilitation in order to relearn
how to breathe, talk and even how
to chew his food.
He forgot how to do everything,
Pam says. He pretty much was an
infant and had to learn how to
breathe again and eat.
EXPERT TIP
REDUCING THE RISK
OF TRAUMATIC
BRAIN INJURY
FOLLOW THESE TIPS TO REDUCE
THE RISK OF BRAIN INJURY:
Always wear a seat belt in a motor
vehicle. A small child should always
sit in the back seat of a car and be
secured in a child safety seat or
booster seat.
Dont drive if you have been drinking
alcohol or doing drugs, including
prescription meds that can impair
your ability to drive.
Wear a helmet while riding a
bicycle, skateboard, motorcycle,
snowmobile or all-terrain vehicle.
Wear appropriate head gear while
playing baseball or contact sports
such as skiing, skating, snowboarding
or horseback riding.
HELP OLDER ADULTS AVOID FALLS

AROUND THE HOUSE:
Install handrails in bathrooms.
Use nonslip mats in the
bathtub/shower.
Remove area rugs or use nonslip
padding beneath them.
Install handrails on both sides
of staircases.
Improve lighting in the home.
Keep stairs and floors clear of clutter.
PREVENT HEAD INJURIES

IN CHILDREN:
Install safety gates at the top
of stairways.
Install window guards.
Use nonslip mats in the
bathtub/shower.
Use playgrounds with shockabsorbing materials on the ground.
Secure area rugs with
nonslip padding.
Dont let children play on fire
escapes or balconies.
Source: MayoClinic.org
WHAT IS TBI?
According to the Centers for

Disease Control and Prevention,
TBI is caused by a bump, blow or
jolt to the head, or a penetrating
head injury that disrupts the
normal function of the brain.
The severity of a TBI can range
from mild (a brief change in
mental state or consciousness, such
as a concussion) to severe, like an
extended coma. A major cause of
death and disability in the United
States, TBIs represent about 30
percent of all injury deaths. In
2010, there were 2.5 million TBIs
in the United States.
With the help of her husband,
Kerry, Pam devoted herself to
caring for John, guiding him
through his recovery and learning
more about TBIs along the way.
She refers to Johns recovery and
continued health problems as
a journey.
Pam became an advocate for TBI
patients and their families before
eventually becoming executive
director of the nonprofit Brain
Injury Association of Tennessee

(braininjurytn.org), which is
based in Nashville. Although she
recently left her position at BIAT
to devote more time to John, now
31, and his medical needs, she
continues to speak to TBI families
and directs a weekly support group
at Vanderbilt University Medical
Center. John, who went on to
graduate high school with an
A/B grade point average, has
served on local and national
advisory councils to promote
TBI awareness and prevention.
Ive always said its not the life
that we had planned, but its a good
life, Pam says. The son who left
for school that morning, the one
I knew for 13 years, never came
home. But I have a son who is still
with us today, and I would not have
changed a thing except for the
accident happening. There is
still life after a brain injury.
FOR MORE INFORMATION VISIT

HEALTH.TN.GOV/TBI/INDEX.HTM.
THRIVE
LIVING WELL IN TENNESSEE
2015 EDITION, VOLUME 1
JOURNAL COMMUNICATIONS INC.

V.P./Content Director SUSAN CHAPPELL
Project Manager/Sales Support JILL WYATT
Contributing Writers TEREE CARUTHERS, REED GALIN, LAURA
HILL, KEVIN LITWIN, SUSAN QUICK, BETSY WILLIAMS
Art Director LAURA GALLAGHER
Senior Graphic Designers HEATHER HAUSER, KACEY PASSMORE,
BRET PELIZZARI, JAKE SHORES, KRIS SEXTON, VIKKI WILLIAMS
Creative Technology Analyst BECCA ARY
Senior Photographers JEFF ADKINS, BRIAN MCCORD
Staff Photographers MICHAEL CONTI, FRANK ORDOEZ,
MICHAEL TEDESCO
Color Imaging Technician ALISON HUNTER
Ad Production Manager KATIE MIDDENDORF
Ad Traffic Assistant PATRICIA MOISAN
Chairman GREG THURMAN
President/Publisher BOB SCHWARTZMAN
Executive Vice President RAY LANGEN
Senior V.P./Operations CASEY HESTER
Senior V.P./Sales JAREK SWEKOSKY
V.P./Business Development CLAY PERRY
Sales Manager JARED LANE
Creative Services Director CHRISTINA CARDEN
Photography Director JEFFREY S. OTTO
Web Creative Director ALLISON DAVIS
Digital Products Designer ERICA LAMPLEY
Controller CHRIS DUDLEY
Senior Accountant LISA OWENS
Accounts Payable Coordinator MARIA MCFARLAND
Accounts Receivable Coordinator DIANA GUZMAN
Database Director DEBBIE WOKSA
Executive Secretary KRISTY GILES
Human Resources Manager PEGGY BLAKE
Health Department News

The mission of the Tennessee Department of Health is to
protect, promote and improve the health and prosperity of
people in Tennessee. TDH has facilities in all 95 counties and
provides direct services for more than one in five Tennesseans
annually as well as indirect services for everyone in the state,
including emergency response to health threats, licensure of
health professionals, regulation of health-care facilities and
inspection of food service establishments. Learn more
about TDH services and programs at health.state.tn.us.
For more information, heres a list of health resources:
cdc.gov
ready.gov
foodsafety.gov
healthiertn.com
fda.gov/default.htm
safesleep.tn.gov
VISIT OUR
ADVERTISERS
BLUECROSS BLUESHIELD
OF TENNESSEE
www.bcbst.com
TENNESSEE HEALTH
CARE ASSOCIATION
www.thca.org
COMMUNITY HEALTH SYSTEMS

www.chs.net
TENNESSEE NURSES FOUNDATION

www.tnaonline.org
Commissioner JOHN DREYZEHNER

Director/Communication and Media Relations WOODY MCMILLIN
COOL SPRINGS SURGERY CENTER

www.coolspringssurgerycenter.com
For additional information contact:
HEALTHWAYS
www.healthways.com
TENNESSEE PRIMARY
CARE ASSOCIATION
www.tnpca.org
Thrive is published annually by Journal Communications Inc.

and is distributed by the Tennessee Department of Health. For
advertising information or to direct questions or comments
about the magazine, contact Journal Communications Inc. at
(615) 771-0080 or by email at info@jnlcom.com.
TENNESSEE DEPARTMENT OF HEALTH

710 James Robertson Parkway
Nashville, TN 37243
(615) 741-3111 or visit health.state.tn.us
No public funds were used in the publishing of this magazine.
Copyright 2014 Journal Communications Inc.,
725 Cool Springs Blvd., Suite 400, Franklin, TN 37067,
(615) 771-0080. All rights reserved. No portion of this magazine
may be reproduced in whole or in part without written consent.
Member
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The Association of Magazine Media

Custom Content Council
Additional Photo Credits PG. 7, 21 DEJAN RISTOVSKI,

PG. 12 GOLDEN PIXELS LLC, PG. 13 JOS LUIS GIRARTE,
PG. 18 ALEXANDER RATHS , PG. 20 ADAM KAZ,
PG. 29 RADIUS IMAGES, PG. 35 HIDESY IMAGES,
PG 50. ALEX LUKIN, PG 54. JASON WOODCOCK PHOTOGRAPHY
LIFEPOINT HOSPITALS
www.lifepointhospitals.com
REGIONAL ONE HEALTH
www.regionalonehealth.org
TENNESSEE BEEF COUNCIL
www.beefitswhatsfordinner.com
TENNESSEE DEPARTMENT
OF AGRICULTURE PICK
TENNESSEE PRODUCTS
www.picktnproducts.org
TENNESSEE STATE PARKS

www.tnstateparks.com
TRH HEALTH PLANS
www.trh.com
UT EXTENSION FAMILY
& CONSUMER SCIENCES
www.fcs.tennessee.edu
VANDERBILT MEDICAL CENTER
www.vanderbilthealth.com
WILLIAMSON MEDICAL CENTER
www.williamsonmedicalcenter.org
TENNESSEE GOVERNORS FOUNDATION

FOR HEALTH & WELLNESS
www.healthiertn.com
BE WELL
SEE MORE RECIPES AT

FARMFLAVOR.COM.
ZESTY CORN AND BLACK BEAN SALSA

WITH LIME CILANTRO DRESSING
Try this twist on traditional salsa using sweet corn, flavorful black beans,
and a tangy lime and cilantro dressing.
Preparation time: 10 minutes

Cooking time: 4 hours (with refrigeration)
Makes: 12 cups (16 servings)
INGREDIENTS
3 cups cooked, fresh sweet

corn kernels (or 1 16-ounce

bag frozen sweet corn kernels,
thawed)
LIME CILANTRO
DRESSING
DIRECTIONS
2 tablespoons extra virgin

olive oil
cup fresh lime juice
2 cans (15 ounces each) black

beans, drained and rinsed
zest of 1 very large lime
1 cup red onion, diced

1 cup green onion, chopped
1 tablespoons garlic,
finely minced
1 very large red bell pepper, diced
1 tablespoon ground cumin
2 jalapeo peppers, finely minced
1 teaspoon kosher salt
2 cups tomato, diced
cup cilantro, chopped
Combine all salsa ingredients

in a large bowl and set aside.
Whisk together olive oil, lime
juice, lime zest, garlic, cumin

and salt in medium bowl. Stir
in cilantro.
Pour over vegetables and
toss lightly to thoroughly

coat all ingredients. Chill
several hours before serving.
Refrigerate leftovers in
covered container.

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THRIVE

LIVING WELL IN TENNESSEE

ITS NEVER TOO

Find the help you need to kick

Tennessee State Parks offer easy

Hit the Trails

Eat, Play, Sleep

Tennessee State Parks offer easy

Thrive: Living Well in Tennessee I 5

Its Never Too

From walking to yoga, its easy to

Tips to help keep your family

Find the help you need to kick

Thrive: Living Well in Tennessee I 7

elcome to the inaugural issue of Thrive, an annual magazine created

hen we started discussing a magazine about living well in Tennessee,

John Dreyzehner, MD, MPH, FACOEM

arenting. Its one of the

Thrive: Living Well in Tennessee I 11

FEWER THAN 30 PERCENT

symptoms or treatment, certain strains can cause

Preteens and teens can be spared from many cancers and

other diseases later in life if they are vaccinated against

and women in Tennessee will go on to develop cancers

HPV. Human papillomavirus, known as HPV, is one of the

and other HPV-related diseases that could have been

most commonly transmitted viruses in the United States.

prevented by this safe and highly effective vaccine.

It is the cause of many cancers including cervical, vulvar,

The HPV vaccine is covered by insurance plans and is

The Centers for Disease Control and Prevention reports

Vaccines for Children program. For more information

79 million Americans have HPV and 14 million more become

about VFC, ask your health-care provider or local health

infected each year. While most infections clear up without

department, or visit www.cdc.gov/hpv.

PETS VS. PARASITES

FARMS AT YOUR FINGERTIPS

A Pick Tennessee Products promotion

We now reach consumers where

NUTRITION FOR NEWBORNS

ONE FOR ALL

Breast milk provides all

One Health advocates a holistic

Studies show that breastfeeding can also help decrease

Regular meetings take place, and all

Thrive: Living Well in Tennessee I 13

14 I Thrive: Living Well in Tennessee

ometimes Hope Ross brings her children

A few years ago, needing time alone to process

MORRISTOWNS PANTHER CREEK STATE

In fact, medical research consistently finds that even

Some studies indicate that people who exercise

RADNOR LAKE STATE NATURAL AREA IN NASHVILLE OFFERS 1,200

doubling that level of activity over time. He even

has given him some trouble. But Phillips exercises

FOR MORE INFORMATION ABOUT TN STATE PARKS,

Thrive: Living Well in Tennessee I 17

DISEASES & CONDITIONS

PROTECT YOURSELF WITH A

nfluenza the flu is not a severe cold. It is a

VACCINES SAVE LIVES

The effectiveness of the flu vaccine varies from

women, the elderly our friends and loved ones. And