easy summer grilling · author, mindless eating: why we eat more than we think 4 health briefs the...

Helping you make the most of your healthcare

11 things the doctor orderedThe technology revolutionizing

healthcareBody image:

What parents need to know

SUMMER 2009

Salmon with citrus salsa & more

Summer GrillinG

EaSy

SUMMER 2009 1

12

26

17

10 Out of the rain A new first aid program teaches

people to recognize and respond to common mental health problems.

By Peter Gallant

12 11 Things the Doctor Ordered

A panel of family doctors prescribes simple steps to improve your health.

by Mary Barlow

17 A Screening and immunization Schedule

Put this list up on the refrigerator —it’s your family’s guide to recommended tests, exams, immunizations, and more.

19 The information Transformation

Learn why health information technology means safer, better care for you and your family.

by Julie O’Connell

22 mirror, mirror Are your kids insecure about their

looks? Here’s what to do. by Peter Gallant

24 Prime Time for lyme Disease

Lyme disease is a serious—but treatable and preventable— illness that affects thousands each year.

by Joseph Rotella

in every issue

features

contents SUMMER 2009

Cover photo by Patrick O’Connor; location courtesy of Colt State Park.

2 First Choice by Julie O’Connell

3 Q&a Brian Wansink, Ph.D. Author, Mindless Eating: Why We

Eat More Than We Think

4 Health Briefs The worst foods for your teeth,

caffeine levels in different foods and drinks, and other tips.

6 Health Quiz Get the Skinny How much do you know about

your body’s largest organ?

7 How To Play Badminton This fun workout helps strengthen

your bones, improve hand-eye coordination, and burn calories.

8 Fitness The Perfect Exercise Find out why swimming is good for

just about everyone. by Beth Adamo

16 The Doctor Is In Your questions answered on

exercising in the heat and skin cancer exams.

by Peter Hollmann

26 Food Hook, Line, & Dinner Grill up an easy summer supper with

this salmon recipe. by Patrick Carney

28 your Choices Running with your dog, female

hair loss, great Web sites for kids, 11 ways to flavor without salt, and more.

32 Picture of Health Tiffani Kiernan St. Louis, Missouri

10

8

6

WINTER 2008 2

*You must continue to pay your Medicare Part B Premium, if not otherwise paid for by Medicaid or by another third party. BlueCHiP for Medicare is a coordinated care plan with a Medicare Advantage contract with the Centers for Medicare and Medicaid Services. The Medicare Advantage contract between Blue Cross & Blue Shield of Rhode Island and the federal government is valid for one year and availability of coverage beyond the end of the current year is not guaranteed. The benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1. Please contact Blue Cross & Blue Shield of Rhode Island for details. Anyone with Medicare may apply, including those under the age of 65 entitled to Medicare on the basis of disability. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. H4152 2009_57 8/2008

You want to experience all that life has to offer. We have preventive programs to help you stay healthy. In fact, Blue Cross & Blue Shield of Rhode Island (BCBSRI) offers a wide range of BlueCHiP for Medicare options, beginning with a low-cost $0* premium plan.

Whichever plan you choose, it’s all backed by our extensive network of community providers. So call today or visit our Web site at www.BCBSRI.com. With the right coverage, anything is possible.

You expect a lot from life.

And even more from your health plan.

Available benefits and services include: • Easy access to customer service: by phone or in person• No referrals required• Vision, dental, and hearing-aid coverage with certain plan options• Plans available with prescription drug coverage • A Living Fit gym membership for just $15 a month

Call 1-888-558-2925 TTY/TDD (Telecommunications Device for the Deaf)

1-877-232-8432

2 SUMMER 2009

FirstChoice

SUMMER 2009 3

Q&A

Brian Wansink, Ph.D.Author, Mindless Eating: Why We Eat More Than We Think

John S. Dyson Professor of Marketing and Nutritional Science, Cornell University

Director, Cornell Food and Brand Lab

Food psychologist Brian Wansink studies the subtle factors that influence why and how much we eat, including the size and shape of our dishes, our proximity to food, the atmosphere of the room, and more. When these external factors affect how we eat without us even knowing it, Dr. Wansink calls this “mindless eating.” We talked with him about how to prevent or reduce mindless overeating.

Choices is issued quarterly by Blue Cross & Blue Shield of Rhode Island. The editorial content of Choices is prepared in accordance with the highest stan-dards of journalistic accuracy. Readers are cautioned, however, not to use information from the magazine as a substitute for regular professional healthcare. Blue Cross & Blue Shield of Rhode Island does not endorse specific products, services, or treatments other than those provided by its benefit plans. This includes any products, services, or treatments that are advertised in Choices.

Editorial OfficesChoices

444 Westminster Street Providence, RI 02903-3279

(401) 459-1000

Copyright 2009 by Blue Cross & Blue Shield of Rhode Island. All rights reserved. Any reproduction, in whole or in part, by any means, without express written permission of Blue Cross & Blue Shield of Rhode Island, is prohibited.

Blue Cross & Blue Shield of Rhode Island is an inde-pendent licensee of the Blue Cross and Blue Shield Association.

Models are used for illustrative purposes only.

BLUE CROSS & BLUE SHIELD OF RHODE ISLAND

Chief Communications OfficerChris Medici

Assistant Vice President Communications Services

Laura Calenda

EditorJulie O’Connell

(401) 459-5747

Art DirectorJuan Cano

Production ManagerDenise Nilsen

Publication ManagerBrian Homsi

Operations ManagerKathy Palumbo

Contributing StaffEditorial . . . . . . . . . . . Beth Adamo, Mary Barlow

Patrick Carney, Peter Gallant Leslie Lowenstein, Joseph Rotella

Design . . . . . . . . . . . . . Peter Campbell, Julie HetuMary Lou Proia, Ero Valesio

Production . . . . . . . . . . . . . . . . . . . . . . . Shari deWolf

Client Services . . . . . . . . . . . . . . . . . Christina Chase Mary-Beth Glavin, Erin Killoran

Jacqueline Ibbitson

Julie O’Connell Editor

CC-5527

Q: What are the biggest “mindless eating” pitfalls that cause people to overeat?

A: There are five situations where people mindlessly overeat . I call them dietary danger zones: meal stuffing, snack grazing, party binging, restau-rant indulging, and desktop/dashboard dining . It has to do with the availability of food, and the absence of anything that tells us when to stop .

Q: Your research has shown that even the researchers themselves can overeat mindlessly. Are we simply wired to make certain decisions about food?

A: I had an ice cream social with some of the world’s greatest nutritional science professors and graduate students . We randomly gave them either regular size or large size bowls, and regular size or large size ice cream scoops . Even though these experts study nutritional science every day, the people who were given large ice cream bowls and large ice cream scoops served themselves 53 percent more ice cream than those who got normal size bowls and scoops .

Q: Given that people seem suscep-tible to mindlessly overeating in so many different ways, what strategies are most important to keep from gaining weight?A: There are two things we can do to prevent mindless eating . First, we can simply reverse all those cues around us that cause us to overeat (see sidebar) . It’s easier to change your environment than it is to change your mind .

The second thing is make it a habit . So, if you start serving all your family meals right from the stove, instead of where you eat, you’ll find that on average, your family’s going to eat about 20 percent less for dinner every night . If you’re used to having seconds or thirds or even fourths, and now you have to get up to get seconds, you’re going to find that thirds and fourths aren’t so likely to happen .

But I’ve found the most successful way is to focus on making one change . I’ve had dozens of people come up to me and say they’ve made one change and they lost weight . It almost doesn’t matter what change the person makes—what does matter is that they do it every day . For example, one person told me they

stopped drinking sugary beverages, and lost 35 pounds in six months . Someone else said they lost weight after they stopped eating food in front of the televi-sion set . Someone told me they never eat lunch or dinner unless they have both a vegetable and a salad on the table . The point is, most of these are reasonably small changes, but they did it every day .

Q: How can decisions we make at the grocery store keep us from mindlessly overeating?A: You’ve heard before, ‘never shop on an empty stomach .’ That advice was born out of the notion that you’re more likely to buy the impulse, snack foods that you’ll eat on the way home . But I think the real problem with shopping when you’re hungry is that it’s going to influ-ence you for a long time because you’re more likely to buy processed food and less likely to buy fresh, whole foods .

Q: Do you have any other tips to help with losing or maintaining weight?A: It’s better to cut 200 calories a day, every day for a year, than to cut 1,000 calories a day, because you’re psychologi-cally and physiologically depriving your-self . And that’s not going to last . If you cut 200 calories a day, you could lose 20 pounds in a year and not even feel it . I

Learn More• Read Dr. Wansink’s book,

Mindless Eating.• Visit the Cornell Food and

Brand Lab’s Web site at foodpsychology.cornell.edu.

Simple Tricks to Avoid Mindless Overeating• Use smaller plates.• Drink from tall and thin glasses.• Use small utensils for serving.• Put unhealthy snacks in top

cupboards or the back of the refrigerator.

• Repackage foods into smaller containers.

• Eat when you’re hungry, not by set mealtimes.

If you’ve ever ended up with an empty bag of

potato chips (or, in my case, an empty plate

of chocolate chip cookies) on your lap and

wondered how you ate all that food, take a

few minutes to read the Q&a on the opposite

page. We interviewed Dr. Brian Wansink, the

author of Mindless Eating, a book about why

we eat much more than we intend to—and

how we can avoid overeating.

You’ll also find tips on healthy eating in our feature article, “11 Things the Doctor Ordered .” We asked three family doctors, “What are the biggest mistakes we make when it comes to our health?” and our eating, exercise, and sleeping habits topped their list . Read about what they prescribe for a longer, healthier life on page 12 .

Eating more fish is one way to improve your diet, since most of us don’t get the recommended two servings a week . The nutrients in this wonder food can help reduce your risk of heart disease, rheumatoid arthritis, depression, and osteoporosis . On page 26, you’ll find ideas for how to turn grilled fish into a quick summer supper, including a recipe for grilled salmon with citrus salsa . I’m not sure which was tastier—the fish or the salsa . Luckily, you don’t have to choose .

And since you’ll already be outside grilling, you might as well put up the badminton net, too . In our “How To” section on page 7, you’ll find instructions for badminton set-up, strategy, and scoring . My husband and I play all the time in the summer, and I’m hoping those tips will help me redeem myself this year .

I hope you enjoy the issue . From all of us at BCBSRI, have a healthy and happy summer!

Send any letters, comments, or general questions to Choices magazine, Blue Cross & Blue Shield of Rhode Island, 444 Westminster St., Providence, RI 02903 or via e-mail to [email protected]. Please include a phone number so we can verify your letter. Letters may be edited for space and clarity.

4 SUMMER 2009 SUMMER 2009 5

HealthBriefs

Food/drink Milligrams of caffeine

Brewed coffee, drip method, 16 oz. 170

Brewed coffee, decaf, 16 oz. 6

Starbucks® brewed coffee, 16 oz. 330

Dunkin Donuts® brewed coffee, 16 oz. 206

Black tea, brewed, 16 oz. 94

Green tea, brewed, 16 oz. 80

Arizona® iced tea, black, 16 oz. 32

Red Bull®, 8 oz. 80

Pepsi®, 12 oz. 38

Mountain Dew®, 12 oz. 54

Chocolate milk, 8 oz. 5

Hershey’s® kisses (9) 9

a Bigger Jolt?When it comes to caffeine, all coffees aren’t created equal.

Most experts recommend adults take in no more than 300 milligrams of caffeine each day (the limit is lower for pregnant women and nursing mothers). But you might be surprised at how much caffeine is in your favorite drinks and foods.

Sources: Center for Science in the Public Interest, U.S. Food and Drug Administration, corporate Web sites. All caffeine amounts are approximate and may vary.

STaTES WiTH THEHiGHEST OBESiTy RaTES

1. Mississippi (31.7%)

2. West Virginia (30.6%)

3. alabama (30.1%)

4. Louisiana (29.5%)

5. South Carolina (29.2%)

6. Tennessee (29.0%)

7. Kentucky (28.4%)

8. Oklahoma (tie) (28.1%)

9. arkansas (tie) (28.1%)

10. Michigan (27.7%)

STaTES WiTH THELOWEST OBESiTy RaTES

1. Colorado (18.4%)

2. Hawaii (20.7%)

3. Connecticut (20.8%)

4. Massachusetts (20.9%)

5. Vermont (21.1%)

6. Rhode island (21.4%)

7. Montana (21.7%)

8. Utah (21.8%)

9. District of Columbia (22.1%)

10. New Jersey (22.9%)

mYTHorFACT ?Bees are attracted to bright colors.

Fact! So wear white, khaki, and other light colors to reduce your chance of being stung.

How BloodDoes GoodNearly five million people receive blood transfusions each year, according to the american Red Cross. Blood donated from volunteers can make the difference between life and death. However, the need for blood transfusions is currently outpacing the number of donations.

EvEry 2 sEconds HoW often

blooD is neeDeD in

tHe UniteD stAtes

38,000 HoW

mAnY blooD DonAtions Are neeDeD everY DAY

5

PerCentAGe of eliGible U.s.

PoPUlAtion WHo Gives

blooD

10-12nUmber

of Pints of blooD in tHe

HUmAn boDY

3HoW mAnY lives eACH DonAtion CAn HelP

sAve

1HoW

mAnY Pints Are Given DUrinG A DonAtion

EvEry 56 days

HoW often ADUlts CAn

DonAte

State of the nationTwo-thirds of american adults are now overweight or obese. Childhood obesity rates have nearly tripled since 1980, from 6.5 percent to 16.3 percent. Those are just two of the facts in the 2008 report How Obesity Policies are Failing America. The report (healthyamericans.org/reports/obesity2008) provides information on obesity in every state. No state saw a decrease in obesity from the previous year.

Gummy bears, fruit roll-ups, raisins, and lollipops. Sticky treats cling to your teeth, so their sugars linger. And long-lasting sugary lollipops are worse for your teeth than a quick snack (even one with the same sugar content).

Better choices: Fresh vegetables and fruit, cheese, whole-grain crackers.

Sodas, sports drinks, and juices. Try to limit these sugary, acidic drinks to one per day, and drink them through a straw.

Better choices: Water, low-fat milk, or tea without sugar.

White bread and potato chips. These starches, which are high in refined sugar and carbohydrates, are often sticky or easily get lodged in teeth.

Better choices: Whole-grain breads (low in refined sugar), baked tortilla chips.

When the sugar in your food interacts with bacteria in your mouth, it results in an acid that attacks your teeth. Generally, the more sugar in a food, the

more risk of tooth decay. Watch out for the worst offenders:


HowTo

How to Play Badminton

Art

by

Len

Shal

ansk

y

Art

by

Ric

k Sh

iers

If you haven’t played badminton since high school phys ed, now is a perfect time to pick up the racket again. This aerobic workout helps you strengthen your bones, improve hand-eye coordination, and burn calories—up to 500 or more during an hour of vigorous play. Plus, it’s easy (and inexpensive) to get started.

FitnessHealthQuiz

1. c. There are about 650 sweat glands per square inch. That’s more than two million sweat glands covering your body! These are vital to regulating your body temperature. On average, people produce about a liter of sweat each day.

2. b. The reladermis is not a layer of skin. The epidermis is your outer layer of skin, and is composed of five sheets of skin. Below this is the dermis, which contains hair follicles and sweat glands. The deepest layer is the subcutaneous (also called the hypodermis), a layer of fat and blood vessels.

3. c. Every skin cell in your body is replaced within three weeks. So every 21 days, you’re walking around in a whole new “birthday suit.”

4. a. Melanin is a pigment produced in the epidermis to protect us from the sun’s ultra-violet rays. Melanin can also be found in your hair and your irises.

5. d. Our skin produces vitamin D, which helps your body use calcium to form and maintain strong bones. Without vitamin D, your bones may become thin, soft, and brittle. Your skin produces vitamin D in reaction to exposure to the ultraviolet radiation in sunlight.

6. b. False. Acne is caused by an obstruction of your pores, and overproduction of oil. The amount of oil your body produces is regulated by hormones. So while chocolate and greasy food may not be healthy, they don’t affect the hormones that regulate oil production.

7. b. The American Academy of Dermatology recommends applying sunscreen every two hours, whether or not you go swimming. You should use a sunscreen with an SPF rating of 15 or higher. Remember to apply sunscreen 15 to 20 minutes before heading into the sun.

Define the court. A regulation badminton court is 17 feet by 44 feet for singles play, and 20 feet by 44 feet for doubles play. For backyard play, just make sure the net evenly divides the court, and that borders are clearly marked with cones, trees, or other objects you won’t trip over. Anything outside the borders is out of bounds. If you’re feeling official, the net should be 5 feet, 1 inch at the poles and slope to 5 feet in the center of the net.

Take positions. Whoever goes first should be on the right side of the court. Stand diagonally across from each other when serving. Hold the racket horizontally, like you are shaking hands with it.

Start the game. Always serve underhand. The goal is to hit the shuttle within the borders of the opponent’s court. (A shuttle that lands on the border is considered in.) In traditional scoring, only the person or team serving can earn points—one for each serve—and games are played to 15 points.

Be ready. Prepare for your oppo-nent’s serve by getting in the ready position. Stand with your feet about shoulder-width apart, knees bent slightly, and your weight on the balls of your feet. Hold your racket in front of you. Your wrist should be at your waist, and the racket head should be about shoulder height. Keep your eyes on the shuttle.

Do the unexpected. Try to surprise your opponent with your shots. If he or she is playing the back of the court, try to drop the shuttle just over the net. Or, if your opponent is playing the middle, hit far into the court so he or she is forced to run backwards for the return.

How to earn pointsThe server earns a point when the opponent:

Doesn’t return an “in” shuttle

Hits the shuttle out of bounds

Hits the shuttle twice

Hits the shuttle into or under the net

Hits the shuttle with his or her body

Reaches over the net to hit the shuttle

44ft

5ft 1in

20ft (doubles)

17ft (singles)

Get the SkinnySkin is the body’s largest organ. On average, adults have 22 square feet of skin, which defends against germs and viruses, provides protection from the sun, and regulates body temperature. Just how much do you know about your own skin? Take this quiz to find out.

2. Which isn’t one of the three main layers of skin?

a. Dermis

b. Reladermis

c. Epidermis

d. Subcutaneous

3. How often does your body replace your skin cells?

a. Every 3 hours

b. Every 3 days

c. Every 3 weeks

d. Every 3 months

4. What substance gives your skin color?

a. Melanin

b. Melatonin

c. Melon

d. Medulla

7. How often should you apply sunscreen if you’re going to be outside on a sunny day?

a. Every hour

b. Every two hours

c. Once in the morning, and once at noon

d. It depends on if you want a tan

6. acne is caused by eating chocolate and greasy food.

a. True

b. False

1. How many sweat glands are in an inch of skin?

a. 20

b. 350

c. 650

d. 1,000

5. What vitamin does your skin produce?

a. Vitamin A

b. Vitamin B

c. Vitamin C

d. Vitamin D

Equipment needed

Badminton rackets

Badminton net

Shuttles (also called birdies)

Stephanie diligently followed her doctor’s orders . After a while, not only did the pain in her back start to improve, but she felt great all over . “There were times when I’d be swimming, and I’d visualize myself as a dolphin speeding through the water with ease,” she says . “I was in the best shape I’d been in years .”

A “one-stop shop”Most people know that physical activity is an essential part of a healthy lifestyle . But for people like Stephanie who have a physical limitation, getting enough exercise can be even more challenging . Swimming is an excellent form of exer-cise for just about everyone—young and old, pregnant women, people with injuries or other limitations, and anyone who’s looking for a great overall workout .

Swimming really is a “one-stop shop” when it comes to exercise . You get a great total body workout that combines flex-ibility, strength training, and aerobics all at the same time .

unparalleled health benefits Regular swimming can improve your health and fitness like few other single exercises can . Here’s how:• Tones muscles – With the increased

resistance of the water, swimming tones your arms, legs, torso, and almost every other muscle in your body . The best swim strokes for total body toning are freestyle, breaststroke, and backstroke .

• Reduces risk of injury – The buoyancy of the water provides a safe, low-impact workout that can effectively increase strength and flexibility, without putting undue stress on joints .

Fitness

For years, Stephanie, 34, had suffered

from lower back pain. One day it

got so bad, she couldn’t stand up

straight. “My doctor, who was an

orthopedic specialist, prescribed

physical therapy—and he told me to

go swimming three times a week for

30 minutes,” she says. “He explained

that the weightlessness of being in

the water would cushion my spine

and help relieve the pain.”

The PerfectexerciseFind out why swimming is good for just about everyone.

by Beth Adamo

• Improves cardiovascular health – Swimming stimulates circulation and is medically proven to lower high blood pressure and cholesterol and decrease the risk of heart attack, stroke, and diabetes .

• Relieves stress – Swimming increases the flow of blood and oxygen throughout your body, which helps regulate breathing, increase lung capacity, and reduce stress .

Getting startedMaking swimming part of your fitness routine is a smart choice . If you have health issues, however, be sure to check with your doctor or healthcare provider before you begin . Once you get the green light, you’ll need:• Access to a pool • A comfortable, durable swimsuit• Goggles• A commitment to swim on a

regular basis • Kickboard and fins (helpful,

but optional)In swimming, there are a variety of

different strokes, including freestyle (front crawl), breaststroke, backstroke, sidestroke, and butterfly . Like any exer-cise, you get the most benefit from each stroke by doing it correctly . If you’re not sure about your technique, take a refresher class or ask a skilled swimmer to watch your form and give you feedback . Here are some additional tips to help you start a safe, effective swimming routine:• Start slowly and build. As you

become more comfortable in the water, gradually push yourself faster and longer .

• Alternate between high-intensity strokes (freestyle) and lower intensity ones (sidestroke or simple laps with a kickboard) .

• Make it a point to extend and stretch your body with each stroke .

• Focus on your breathing to build endurance and feel more relaxed .

• Go at your own pace. I

Knowing swimming etiquette will make for a safer, more enjoyable pool experience.

Swim in the lane that’s appropriate for your level. Most pools designate

lanes “fast,” “intermediate,” and “slow.” Take a moment to watch other swimmers

to determine which lane is best.

if there are more than two swimmers

in a lane, swim in circles to avoid bumping into other swimmers.

This means you go up one side of the lane and return on the other side.

If you’re unsure about anything,

ask the lifeguard for assistance.

3Rules of the Pool


SUMMER 2009 1110 SUMMER 2009

rainby Peter Gallant

Mention first aid, and

most of us think of

someone giving CPR, applying

pressure to a wound, or

bandaging a sprain. But

programs around the country

are working to expand the

definition of first aid to

include mental health.

According to the U .S . Department of Health and Human Services, an esti-mated one in four adults suffers from a diagnosable mental disorder in any given year . But fewer than half of them get help, and that can have serious consequences . Mental Health First Aid (MHFA) was created to help address this widespread health issue—by teaching people how to recognize and respond to common mental health problems .

First developed in Australia, MHFA is being piloted by a handful of organiza-tions here in the United States, under the coordination of the National Council for Community Behavioral Healthcare . One such organization is Gateway Healthcare, a nonprofit mental health center in Pawtucket, Rhode Island .

Richard Leclerc, President of Gateway Healthcare, says the real backbone and value of MHFA training is that it’s a meaningful way for everyday people to help out other everyday people who might be suffering through a mental health problem or crisis . Leclerc says, “We want to create the mental health equivalent of a first responder who knows how to perform CPR on someone who’s had a heart attack and can assist the victim until proper medical help can be secured .”

A better chance at better outcomes Leclerc says MHFA is designed to increase trainees’ knowledge and awareness of mental health, reduce stigma, and most importantly, increase supportive actions .

Blue Cross & Blue Shield of Rhode Island is the lead sponsor of Gateway Healthcare’s 12-hour MHFA program, which is open to the general public . In the program, participants learn: • How to recognize the signs and

symptoms of mental health disorders such as anxiety, depression, psychosis, and addiction

• How to approach someone in a mental health crisis

• How to be supportive, diffuse the situation, and encourage professional help

• What to do if someone is suicidal, harms them-selves, or refuses help

What the program doesn’t do, Leclerc says, is teach people to be therapists or doctors: “This program doesn’t require participants to have a high level of exper-tise about medical care or a behavioral health background,” he points out .

early interventionParticipants in Gateway’s MHFA program range from police officers to high school students . “Our trainees’ stories are quite compelling,” says Mary Cimini, Director of LifeWatch EAP, a division of Gateway . For example, in separate instances, Cimini says two students used their newly acquired skills

almost immediately (between sessions one and two of their training) to inter-vene and assist friends who were suicidal . “Fortunately, our first-aiders were trained to recognize patterns and ask the right questions,” Cimini explains .

“They followed appropriate protocol and were able to direct the individuals to professional behavioral healthcare services, where they got the help they needed .”

As is the case with any medical condition, the sooner mental health issues are iden-tified and treated, the better . “Early intervention is always the best course of action,” says

Cimini . “This program aims to develop a ministry of presence among our first-aiders and the general public concerning mental health issues .”

Among the first to be certified in MHFA were members of law enforce-ment and those employed at social community organizations, primarily because they’d be more likely to encounter people in this at-risk popula-tion . To date, more than 200 people have received MHFA certification through Gateway since the program was launched in May of 2008, including 102 officers from the Rhode Island Municipal Police Academy . And, additional trainers are being added to accommodate an antici-pated rise in enrollment . I

For more on MHFaGateway Healthcare gatewayhealth.org/MentalHealthFirstAid.asp

- To enroll in a MHFA class in Rhode Island, download the enrollment form on this site or call (401) 724-8400, ext. 236.

The National Council for Community Behavioral Healthcare thenationalcouncil.org/cs/mhfa_in_the_us

- This site explains more about MHFA and lists all U.S. communities that have certified MHFA instructors.

a new first aid program teaches people how to recognize and respond to common mental health problems.

• Greater confidence in providing help to others

• Greater likelihood of advising people to seek professional help

• Decreased stigmatizing attitudes

One unanticipated benefit of the program was that participants improved their own mental health by taking part in MHFA training.

Source: National Council for Community Behavioral Healthcare

Outof the

Proven results

Art by Paul Blow

Studies have found that those who trained in MHFa have:


11Things the Doctor

Ordereda panel of family doctors prescribes simple steps to

improve your health. By Mary Barlow

Don’t smoke. a smoker’s risk of heart attack is decreased within 24 hours after quitting.

Within a few months, circulation improves, walking gets easier, and lung function improves . Within a year, the risk of coronary artery disease is half the risk of a smoker . And in addition to the tremendous health benefits, quitting smoking saves money—a lot of money . “[Over 5 years], people who smoke a pack a day pay about the same amount as tuition for four years at a state college,” says Jeffrey M . Borkan, M .D ., Ph .D .• Visit Smokefree .gov for free information and Web support . • Call 1-800-QUIT-NOW for a free service with educational

materials and coaches to work with you over the telephone .

eat healthy and move more.Too often, we put off losing weight, thinking that a few more months (or years) won’t matter. But they do.

“While we may be able to lose weight at any time, we cannot reverse many health problems caused by obesity,” says Lynn Ho, M .D . “Once you have really bad arthritis, losing weight will help, but you’ll still have the condition .”• Dr . Simon suggests

improving your diet by replacing one unhealthy meal or food item at a time

with something healthy:– Say you normally have

sausages and toast for breakfast, a roast beef sandwich for lunch, and meat and potatoes for dinner . Start by changing only your breakfast . Instead of your usual meal, have something like high-fiber cereal, fresh blueberries, and low-fat milk .

– Once you’re used to doing that, tackle lunch and so on . “It’s not an all or nothing,” says Dr . Simon . “If you slip up and have sausages for breakfast again, pick yourself up, dust yourself off, and start over again .”

• To find out how much exercise you need, visit cdc .gov/physicalactivity/everyone . This site breaks down fitness by age and shows what you need to do for general health or to get six-pack abs .

manage any chronic diseases. If you have heart disease, diabetes, asthma, depression, or another chronic disease, you can improve how you feel and reduce your

risk for complications by following your doctor’s advice and paying atten-tion to warning signals.• Learn everything you

can about your condition through books, reliable Web sites, and other literature .

• Join BCBSRI’s health coaching program . As part of your plan at no extra charge, BCBSRI teams you up with a nurse or dietitian who can help you control your condition . To learn more, call (401) 459-2273 or 1-800-637-3718, ext . 2273 .

ur daily habits are putting us at risk. That’s what three family doctors said when

we recently asked them, “What are the biggest mistakes we make when it comes to

our health?” Considering today’s health trends, they said, what we eat and drink, the

amount of exercise we get, and the way we deal with stress just isn’t good.

Read about our panel of expert doctors on page 15.

So while recommendations like, “exercise and eat right” echo the tone of our parents’ mantras to “button your coat because it’s cold outside,” they remind us that we really need to pay attention to, well, the obvious .

“The concepts are so simple that they may seem

trivial in a medical culture dominated by MRI, gee-whiz surgery, and genetically engi-neered drugs,” says Harvey B . Simon, M .D .

Today about 66 percent of Americans are overweight, more than double the number in the mid-seventies . About 39 percent of us don’t exercise

at all, and 22 percent still smoke . These and other factors are resulting in signifi-cantly higher rates of chronic (ongoing) disease . About 125 million Americans are suffering with conditions such as diabetes, heart disease, asthma, arthritis, depression, and backaches .

Here are 11 things that our panel of doctors prescribes for a longer, healthier life.

14 SUMMER 2009 SUMMER 2009 1514 SUMMER 2009 SUMMER 2009 15

eat together.Sports, after-school activities, work schedules—these all challenge our ability to have family dinner-times, but making an effort is worth it.

“There are nutritional benefits, it improves the well-being of children, and models family life and manners,” says Dr . Borkan . “Eating dinners together decreases the risk of unhealthy weight . Kids eat more fruits and vegetables and do better in school .”

According to the 2002 National Survey of American Attitudes on Substance Abuse VII: Teens, Parents and Siblings, “Teens who eat dinner with their family six to seven times a week are at almost half the risk of substance abuse as teens who eat dinner with family twice a week or less .” • To make the most out of

your dinner ritual, turn off the television, dim the room, and light a candle .

• Sit at the table, and talk about everyone’s day, but refrain from arguments .

• It’s also important to define difficult terms for children so they can follow the conversation, which helps develop their vocabularies .

Turn off the TV and read a book.“We should be reducing television to one hour or less per day,” says Dr. Borkan. “Television is reducing compre-hension. It is passive learning, while reading stretches the mind.”• Set limits on television and

Internet time .

• Keep soft music on in your home for background sound .

• Sit in a quiet room and read, and maybe, just maybe, your kids will come in and pick up a book, too .

manage stress.“Stress suppresses important parts of the immune system, and can leave you open to disease,” says Dr. Ho. “If you have a disease, stress makes it worse.”• Dr . Simon

notes that exercise promotes emotional well-being, and helps reduce stress, anxiety, and depression .

• To learn tips for managing stress, visit helpguide .org .

maintain strong social connections.“Having friends decreases your stress levels,” says Dr. Ho. People who are married or have deep social ties tend to fare better

in terms of health and happiness than people who do not have strong social connections.• Stay in close contact with

friends and family .• Extend your social network

by volunteering, taking a class, or pursuing other interests you enjoy .

Protect your skin.Just one sunburn can increase your risk of skin cancer. • Use a sunscreen

with a sun protection factor (SPF) of at least 15 every day on exposed areas of the body . Be sure to choose a “broad spectrum”

sunscreen, which protects against both forms of ultraviolet radiation .

• Wear a wide-brimmed hat, long sleeves, and pants .

Hold the salt.The recommended daily amount of sodium is just one teaspoon a day (2,300

milligrams). For people with hypertension, and for middle-aged and older adults, the recommenda-tion is 1,500 milligrams. Too much can lead to high blood pressure and other health problems.

“Seventy percent of salt in our diets comes from processed and prepared foods, and they cost more money,” says Dr . Borkan .

“I recommend that people eat more whole foods . Packaged foods are worse for your wallet and worse for your health .”

• Eat more home-cooked meals made with fresh meats and vegetables, rather than prepackaged items .

• Use herbs and spices rather than salt to flavor food . (For more information, see page 31 .)

Get your rest.We often think it’s no big deal to miss a bit of sleep every night. However, Dr. Ho says, “a lack of sleep decreases your level of concentration and focus, and makes it hard to receive and integrate information.”

Night after night of lost sleep can lead to depression and anxiety, as well as poor balance and falls .• Don’t drink coffee after

morning hours or alcohol before bedtime .

• Exercise regularly, but not within a few hours of bedtime .

• For more tips on getting a good night’s rest, visit sleepfoundation .org .

Get screened.Getting all of your preventive screenings and vaccines for your age and health status can help you detect diseases early, and in some cases, avoid them altogether. • Be sure to call your

doctor to have any unusual symptoms checked out .

• To find out what preven-tive care you and your family should have, see the screening and immu-nization charts on pages 17-18 .

Jeffrey M. Borkan, M.d., Ph.d.Professor and Chair, Department of Family Medicine, Brown University

Physician-in-chief, Memorial Hospital of Rhode Island

An educator, researcher, and clinician, Dr. Borkan is the author of numerous articles and chief editor of a recent book, Patients and Doctors. A recog-nized authority on qualitative research in primary care, Dr. Borkan’s interests include patient narratives, low-back pain in primary care, and public partici-pation in health policy decisions.

Lynn Ho, M.d.Family Doctor North Kingstown, RI

As a pioneer in today’s family medicine, Dr. Ho runs her own “micro-practice.” Micro-practices have fewer patients than traditional practices and are highly efficient, despite employing no recep-tionists or medical billing staffs. This structure allows micro-practice physi-cians more time with patients at no additional cost to them or their insurers.

Harvey B. simon, M.d.Associate Professor of Medicine Harvard Medical School

Founding Editor, “Harvard Men’s Health Watch” Newsletter

A member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology, Dr. Simon has authored scores of magazine and newspaper articles, scientific articles, and medical text book chapters. He has also written a number of books on healthy living, including The No Sweat Exercise Plan.

Meet our panel of doctors.all of our panelists are practicing family physicians.


Please cut here and keep for your records.

A Screening and immunization Schedule

CHilDren

Bir

TH

1 m

onth

2 m

onth

s

4 m

onth

s

6 m

onth

s

9 m

onth

s

12 m

onth

s

15 m

onth

s

18 m

onth

s

24 m

onth

s

3 ye

ars

4 ye

ars

6 ye

ars

10 y

ears

11 y

ears

12 y

ears

AD

Ole

SC

enT

13-1

9 ye

ars

TeSTS

Blood Lead Screening Each year from ages 9 months-6 years1; ages 3-6 years, ask your child’s doctor

HiSTOrY/exAmS

Medical History/Checkup At birth, at ages 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, and 30 months Once a year starting at age 3

Dental ExamAt 18, 24,

and 30 months2

Routine visits starting at age 3

immunizATiOnS

Hepatitis B (Hep B)3

Hep B #1

Hep B #2

Hep B #3

Diphtheria, Tetanus, Pertussis (DTaP3/Tdap)

DTaP #1

DTaP #2

DTaP #3 DTaP #4 DTaP #5 Tdap

H. Influenza Type b (Hib) Hib #1

Hib #2

Hib #34 Hib #4

Inactivated Polio (IPV)3 IPV #1

IPV #2 IPV #3 IPV #4

Pneumococcal Conjugate (PCV)

PCV #1

PCV #2

PCV #3 PCV #4

Rotavirus (RV)5 RV #1

RV #2

RV #3

Influenza (Flu) Yearly for healthy children aged 6 months and older

Hepatitis A (Hep A)Between ages 12-24

months (2-dose series, 6 months apart)6

Measles, Mumps, Rubella (MMR)

MMR #1 MMR #2

Varicella (Var) Chickenpox Var #1 Var #2

Human Papillomavirus (HPV)

Females aged 11-12 years

(3-dose series, 2 months

apart)

Females aged 13-26 if not previously immunized

Meningococcal Conjugate (MCV4)

MCV4If not

previously immunized

HeAlTH GuiDAnCe

Safety (bicycle and water safety), poison control, car seat safety, seatbelts, helmets, violence prevention, nutrition, physical activity, family planning, sun exposure, AIDS/STD prevention, sex, physical abuse, drugs/alcohol, smoking, weapons, television viewing

These items should be discussed at checkups at appropriate ages.

Recommended age range

Catch-up immunizations

Got a question? e-mail your health question to [email protected], or mail it to:

While Dr. Hollmann cannot respond to letters personally, he’ll answer as many as possible in the next issue.

The information provided through this column is intended solely for general information and should not be relied upon for any particular diagnosis, treatment, or care. Always consult with your doctor for appropriate examinations, treatment, testing, and care recommendations.

The Doctor’s inc/o Choices444 Westminster Street Providence, RI 02903

TheDoctor’sin

By Peter Hollmann, M.D.associate Chief Medical Officer, Blue Cross & Blue Shield of Rhode Island

Dear Dr. Hollmann, I was wondering when it’s too hot to exercise outdoors. My teenage daughter runs outdoors all summer, no matter what the temperature. I’m worried that she’ll get heatstroke.

Heatstroke and heat exhaustion are real health concerns . We’ve all read about the tragic deaths of high school and even professional athletes training in the summer . Heat kills more people than any other weather condition .

Of the 400 Americans who die each year from heat-related illness, many are elderly who are in homes without air conditioning . However, the typical victim of heatstroke caused by exertion is an athlete or military recruit .

To see if it’s too hot to exercise, try checking the heat index, which is a combination of temperature and humidity . If the heat index is over 90, it’s not a good idea to do strenuous activity like running . The National Weather Service has a useful chart (weather .gov/om/heat) that both calcu-lates the heat index and divides the index

into risk categories of caution, extreme caution, danger, and extreme danger .

During the hotter months, people who exercise outdoors should do so during the coolest times of day, usually early morning and evening . If doing strenuous activity, stay well hydrated with an electrolyte-balanced fluid (such as a sports drink), be alert for danger signs of heat illness, and exercise with a partner .

Along the way, exercisers should take breaks, drink, and pay attention to their bodies . The earliest sign of heat problems may be heat cramps . Cramps, nausea, headache, weakness, or dizzi-ness is considered heat exhaustion, which requires immediate rest, cooling, and drinking fluids . If not treated, heat exhaustion can become heatstroke, which can cause kidney failure or even death .

Heatstroke is a life-threatening condition that can cause confusion, loss of consciousness, and inability to catch breath with rest . It cannot be treated with rest, shade, and fluids . Seek emergency medical attention, and while waiting, cool the person off as quickly as possible . These emergency situations are why it’s best to always exercise with a partner .

Dear Dr. Hollmann, Should everyone see a dermatologist for skin cancer exams? Or is that just for people with risk factors? I’ve had sun poisoning several times, and my friend says I should see a dermatologist every year.

For most people, the best time for skin exams is during regular preven-tive health visits with your primary care physician . Of course, some people do require annual skin exams by a dermatologist, such as those with many pigmented or odd-appearing moles or a history of skin cancer . But while being fair-skinned and having overexpo-sure to sun may be risk factors, they don’t necessarily warrant derma-tologist visits .

While all forms of skin cancer need attention, many are typically slow growing . The real issue is melanoma, as this type of skin cancer can be fatal if not diagnosed early . Melanoma occurs in less than five percent of skin cancer cases, and is rare in children . Primary care physicians do reasonably well in recognizing melanoma, or will know when to refer you to a dermatologist .

The best ways to help prevent skin cancer are to get regular general medical care and use sunscreen with an SPF of at least 15 . If you’d like more informa-tion on sun safety, and skin self-exams, please visit the American Academy of Dermatology at aad .org/public . I

1 A Rhode Island state guideline.2 These visits provide important educational information and help estab-

lish a dental home for children. Visits do not include routine exams.3 The Rhode Island Department of Health currently provides a combi-

nation shot of Hep B, DTaP, and IPV. The recommended shot schedule will vary depending upon which shots the infant has already received.

4 Depending on the brand of Hib vaccine used for the first and second doses, a dose at 6 months of age may not be needed.

5 Depending on the brand of vaccine used, the schedule may vary.6 Children not fully vaccinated by age 2 can be vaccinated at subsequent

visits. The Hepatitis A vaccine is also recommended for children older than 1 year who live in areas where vaccination programs target older children or who are at increased risk of infection.

18 SUMMER 2009

The InformationTransformationLearn why health information technology means safer, better care for you and your family.

by Julie O’Connell

SUMMER 2009 19

ADulT

20 y

ears

25 y

ears

30 y

ears

35 y

ears

40 y

ears

45 y

ears

50 y

ears

55 y

ears

60 y

ears

65 y

ears

70 y

ears

75 y

ears

80 y

ears

CAnCer SCreeninGS

Pap smear7 Every one to three years if sexually active or over age 21 (whichever comes first), until age 65 (Include chlamydia screening for sexually active females up to age 25.)

mammography7 Annually beginning at age 40

Colorectal screening Begin at age 50 and continue until age 75. Discuss best method for testing with your doctor.

exAmS/TeSTS

blood Pressure Every two years if previously normal without medication (Normal= <120 over <80)

Cholesterol test (total and HDl) Begin routine screening for men at age 35 and women at age 45. Men and women with risk factors for heart disease should be screened starting at age 20.

osteoporosis7

Begin routine screening for women at age 65. Women at increased risk for osteoporotic fractures should

begin screening at age 60 .immunizATiOnS

Pneumococcal Once8

tetanus/Diphtheria/Pertussis (td/tdap) Every 10 years.Tdap should replace a single dose of Td for adults aged 19 to 64 who have not received a dose of Tdap previously.

influenza (flu) Every year starting at age 50.Also recommended for high-risk individuals at any age, including people who smoke or have asthma or other chronic conditions.

Herpes Zoster Shingles Once, for those aged 60 and older

Human Papillomavirus (HPv)7

Up until age 26 if not

previously immu-nized

varicella Chickenpox

Once, for people aged 20-30, if not previously immu-nized or have not had chickenpox

HeAlTH GuiDAnCesmoking, alcohol and drugs, physical abuse and family violence, physical activity, nutrition, obesity, injuries (motor vehicle, household, and recreational), Hiv/stD, family planning

Periodically

7 Tests for women.8 If pneumococcal vaccine is received prior to age 65 and more than

five years have passed since the previous dose, a revaccination is recommended after age 65.

Sources: Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, Rhode Island Department of Health, and U.S. Preventive Services Task Force

Plea

se c

ut h

ere

and

keep

for

you

r re

cord

s.

If you think you or a family member may not have received immunizations listed in this chart, consult the appropriate healthcare provider for catch-up immunizations.

These guidelines are for people with no current medical conditions, related family history, or other risk factors. If you have such factors, you may need additional services.

A Screening and immunization Schedule Recommended age range

Catch-up immunizations

Before electronic medical

records were available,

David Gorelick, M.D. made

his own.

after medical school, he

served as a doctor in the

military during the Gulf

War, and learned to use

computers on a Navy ship.

He applied that knowl-

edge when he started his

internal medicine residency

in 1991. “I made a database

so I could track patients’

medical histories, allergies,

reminders to myself,”

Dr. Gorelick says. “It helped

me keep track of labs and

tests I was ordering, so

I could make sure that

patients actually had the

tests, and what the results

were. It was much more effi-

cient than paper records.”

But as useful as Dr . Gorelick’s system was, he still had to use paper charts as well . All that changed in 2005, when his group, Aquidneck Medical Associates, became one of the first practices in Rhode Island to implement electronic medical records (EMRs) through the Quality Counts Program . (See “Investing in better health” on the opposite page .) EMRs are computerized medical files that store patients’ infor-mation, including medical histories, treatments, prescriptions, test results, and more .

And Dr . Gorelick is very pleased with the results: “I can

see many patients with complex prob-lems, find information within seconds, document progress notes, order labs, transmit prescriptions electronically, and review documents and telephone messages more efficiently than would ever be possible with paper charts .”

His EMR system also includes an “outstanding orders” feature that iden-tifies tests that have been ordered but not yet performed . He says, “Several malignancies were discovered as a result of rescheduling overdue tests that were recognized through outstanding orders . Without this feature, some of these cancers may not have been discovered in time to provide a cure .”

The way aheadEMRs have received a lot of attention in recent months, thanks to the American Recovery and Reinvestment Act of 2009 . This federal economic stimulus program allotted $19 billion in funding and incentives to encourage doctors and hospitals to purchase and use EMRs . Here’s a quick look at how this new technology can help improve healthcare:• Reduced medication errors. With

EMRs, doctors can keep a list of a patient’s medications—from prescrip-tions to over-the-counter drugs to supplements—in one secure location .

And EMRs can alert physicians to any potential drug interactions or allergic reactions . Doctors can also e-prescribe by sending prescriptions directly to a pharmacy using an EMR . Dr . Gorelick, who was recently named one of the top e-prescribers in the country, says e-prescribing helps cut down on medical errors due to handwriting .

• Improved quality of care. EMRs remind doctors about important tests and screenings a patient needs, such as a routine mammogram or a hemoglobin A1c test for a person with diabetes . Use of EMRs has even been linked to fewer deaths during hospital-izations . A January 2009 study in the Archives of Internal Medicine reported a significant reduction in patient deaths in hospitals where electronic records are used . The study also found that the more health information tech-nology the hospital used, the greater the reduction was in patient deaths .

• Lowered costs. According to the New England Journal of Medicine, the cost of purchasing, installing, and implementing an EMR system is esti-mated to be $40,000 . However, over the long term, EMRs save money for physicians, patients, and the health-care system as a whole through fewer duplicate tests, improved efficiency, improved quality of care, reduced administration time, and more .

A RAND study estimates the savings will be $80 billion per year when 90 percent of doctors are using EMRs .

Currently, the rates of EMR adoption are fairly low for small practices (ranging from 9 to 30 percent), with significantly higher rates for large practices and hospitals (ranging from 50 to 68 percent) . However, even before the stimulus funding was announced, a New England Journal of Medicine survey found that 26 percent of doctors without EMR systems planned on buying one within the next two years .

The information exchangeRight now, the information that Dr . Gorelick puts into his EMR can only be accessed by the other doctors in his practice . It doesn’t connect to the specialists his patients visit, or the labs where they get their tests . If one of his patients has a medical emergency, the valu-able patient information in his EMR is not readily available to emergency room doctors . But soon, that will change .

Rhode Island is one of a handful of states around the country—others include Massachusetts and California—

developing a health information exchange (HIE) . This means that, with a patient’s permission, doctors’ offices, pharmacies, labs, and other healthcare providers across the state will be able to access each other’s medical informa-tion when it’s needed to provide care . So if you go to a specialist, he or she will be able to access all your up-to-date medical records, and see results of any tests and screenings you’ve already had . And if you were in an accident or situa-tion where you were unable to provide medical information, the hospital would be able to locate it quickly through the HIE . This will help ensure that you receive the best possible care .

Dr . Gorelick is on the Clinical IT Leadership Committee of the Rhode Island Quality Institute, the organi-zation leading the development of Rhode Island’s HIE, called currentcare . He says, “Interconnectivity through currentcare will be invaluable to patients, as any of their physicians at any location will have secure access to their health information .”

To give healthcare providers access to important health information through currentcare, Rhode Islanders should sign up at currentcareri.com . People outside of Rhode Island should contact their local Department of Health to ask about an HIE . I

investing in better health

Estimated savings will be $80 billion per year when 90 percent of doctors are

using EMRs.

lowered Costs

at Blue Cross & Blue Shield of Rhode Island (BCBSRI), we believe EMRs and a statewide HIE are essential to improving quality of care and helping control healthcare costs. That’s why we fund programs and organizations that encourage doctors to adopt this important technology:

• BCBSRi QualityCounts Program Aquidneck Medical Associates, Dr. Gorelick’s practice, was one of the first groups to enroll in this three-year pay-for-performance program, which partially funds EMR implementation for 80 doctors. Initial findings indicate that EMRs help increase the number of patients who receive immuniza-tions, screenings, and other preven-tive care. EMRs also help doctors improve quality of care for patients with chronic conditions.

• BCBSRi EMR GrantsPrimary care physicians and select specialists can apply for grants to help support the purchase of EMRs, or to assist with the costs of EMRs that they currently use.

• additional primarycare funding Outside of the Quality Counts Program and EMR Grants, BCBSRI has provided funding to 125 primary care physicians for EMR implementation.

• Rhode island Qualityinstitute (RiQi)BCBSRI is a lead sponsor of the RIQI, supporting both the state-wide adoption of EMRs and currentcare. For more information, visit riqi.org.


Dr. David Gorelick’s EMR system includes an “outstanding orders” feature that identifies tests that have been ordered but not yet performed. He says, “Several malignancies were discovered as a result of rescheduling overdue tests that were recognized through outstanding orders.”


We all remember that growing up comes with its share of awkward moments . But that doesn’t mean all insecurities about developing bodies are simply part of that normal process . Children with unrealistic expectations about their appearance and associated self-esteem issues can run into poten-tially serious health consequences if these problems are not addressed . For example, anorexia is now the third most common chronic illness among adolescents . Also, once established, eating disorders, nega-tive body images, or any unhealthy behav-iors become more difficult to reverse and routinely carry over into adulthood .

If you’re hearing your child say things like, “I’m too fat,” “I’m too short,” or “My ears are too big,” it’s time to have an honest, open discussion about what is (and isn’t) a healthy body and self-image . This is especially important if you notice that your child is avoiding social situa-tions, spending inordinate amounts of time in front of the mirror, or obsessing over a particular perceived defect .

Be a good role model“Parents need to be savvy about what it means to be healthy, and their actions should set a good example,” explains Kathy J . Kater, a Minnesota-based psychotherapist and social worker and author of the book Healthy Body Image: Teaching Kids to Eat and Love Their Bodies Too! That means moms and dads need to eat well, stay active, and avoid unhealthy behaviors them-selves . After all, if they’re always going on (and coming off) the latest fad diet,

for example, their kids will think that’s healthy and effective behavior .

Kater also advises that parents avoid making comments that reinforce image over health . For example, don’t play up how muscular a professional athlete looks or how attractive a celebrity might appear after he or she has lost weight or had cosmetic surgery . Conversely, “Don’t say things like ‘I was bad this weekend’ just because you went to Dairy Queen,” she says . It’s fine to treat yourself once in a while, she points out, as long as such indulgences don’t interfere with an overall habit of wholesome eating .

So don’t beat yourself up, especially in front of your kids . Rather, strive to emphasize the choices needed to support health, focusing on an individual’s char-acter, personality, and talents, not his or her appearance . Remember, if you want your kids to understand and accept that people come in all shapes and sizes—and that’s OK as long as they’re healthy—you have to believe it, too .

image isn’t everythingOur kids are growing up watching media that often feature people who are too thin, while the average people around them are becoming more overweight (despite the fact that Americans spend more than $40 billion a year on diets and weight-loss products) . To help our chil-dren be healthy, we need to teach them how to be healthy—and that a healthy body is a happy body . (See sidebar for additional tips .) And, most importantly, we need to make sure they know that “Image isn’t everything .” I

are your kids insecure about their looks? Here’s what to do.By Peter Gallant

Focus on Good Health . . . not Good looksHere are a few more things parents can do to help their kids (and themselves) become more comfortable with the bodies they have—and stop stressing over the ones they don’t have.

accept body-size diversity. “We come in all shapes and sizes,” says Kater. Even fit, well-fed bodies naturally range from tall to short, and lean to larger. Genetics, too, play a major role. So as long as you are healthy, embrace your shape—whatever it is.

Focus on healthy habits. Many people try to lose weight through fad diets that cut out certain food groups or have eating plans that can’t be sustained for the long term. “Restrictive eating is the number one catalyst for binge eating,” Kater says, “and I’ve seen many clients ‘diet’ themselves into larger and larger sizes.” It’s much more important to teach your kids healthy habits that will last a lifetime, such as eating nutri-tious foods and being active.

Teach and stay involved. “You teach your kids the value of a dollar and how to spend money wisely. You can take the same approach with teaching them about eating and exercise,” Kater says. Kids will understand, for example, that it’s OK to buy a CD with their allowance as long as they’ve put some away for savings. Similarly, you can teach them that it’s OK to have a cookie if they’ve taken care to “spend” most of their hunger on a good variety of wholesome foods at regular meals and snacks.

“IMAGE IS EvERytHInG.”years ago, that was the tagline of a popular advertising

campaign featuring tennis star andre agassi. If you’re

old enough to remember that, you might be old enough to

have teen or adolescent children now. These days, many

kids—maybe yours—still believe “Image is everything.”

MirrorMirrorMirrorMirror,


Summertime means spending more time outside. It’s also prime time for ticks and tick bites, especially early in the season. Ticks can transmit diseases—and one of the most common and most serious is Lyme disease.

Prime Time for Lyme DiseaseLyme disease is a serious—but treatable and preventable—illness that affects thousands each year.

Lyme disease affects between 20,000 and 30,000 people in the United States each year, according to the Centers for Disease Control and Prevention . Although cases have been reported in almost all states, it’s highly concentrated in the

coastal northeast, where it is carried by deer ticks . As

their name implies, deer ticks feed on deer, so they’re more common where there is a higher deer popu-lation—for example, wooded and grassy areas . In the northeast, the rising deer population and more housing development in rural areas have contributed to an increase in Lyme disease cases in recent years .

“In Rhode Island alone, more than 700,000 people, or nearly three-quarters of the state’s population, are currently at risk for encoun-tering deer ticks where they live,” says Dr . Thomas Mather, Director of the University of Rhode Island’s Tick Encounter Resource Center (TERC) .

Symptoms may varyLyme disease can cause a variety of symptoms, many similar to those of different tick-caused diseases, as well as other viral infections and disorders . This can make it very difficult for doctors to diagnose it . Typical early symptoms are fever, fatigue, headaches, muscle aches, joint pain, chills, and a distinctive rash .

The rash usually occurs at the bite location anywhere

from three to 30 days after the bite . Similar to a bull’s eye, the rash has a red center, clear area, then a red ring around it . It can grow to five or six inches in diameter and can last for three to five weeks . However, the rash doesn’t occur in all cases, and in some people, different types of rashes develop (such as red spots) . This, coupled with the fact that the rash is the only symptom unique to Lyme disease, contributes to the difficulty of its diagnosis .

Late symptoms (weeks or months after the bite) may include arthritis and pain/swelling of large joints (especially the knees), nervous system abnormali-ties (including temporary paralysis of the facial muscles, or Bell’s palsy), or a markedly slowed or irregular heartbeat . If untreated, patients can develop permanent damage to the joints or nervous system, as well as chronic

arthritis . Additional changes, which may not be as notice-able, may include concentra-tion problems, mood swings, and memory loss .

What to doIf you’ve been bitten by a tick, the first thing you should do is attempt to remove it using tweezers . Avoid crushing the tick as you pull it out, and save it for identification purposes . (For most tick bites, doctors don’t routinely prescribe antibiotics unless you are showing signs or symptoms of Lyme disease .)

If you spotted and removed a tick, and begin experiencing the usual symptoms of Lyme disease, see a doctor . If you don’t develop the rash and/or don’t remember a bite but experience symptoms, your doctor will go through your medical history and give you a careful exam . You may also

have laboratory tests or blood work done .

The sooner patients begin treatment for Lyme disease, the faster their recovery . It can be effectively treated using antibiotics . If Lyme disease isn’t treated in a timely manner, however, early symptoms can persist, and new symptoms can develop . In most cases, these can also be successfully treated with antibiotics .

Currently, the TERC is looking to stop Lyme disease before it starts . “In addition to promoting effective tick bite prevention strategies,” Dr . Mather says, “another part of our mission is to help create new vaccines to prevent the spread of tick-borne diseases, as well as to improve the reliability of diagnoses and treatment .” I

By Joseph Rotella

Avoiding ticks is the best form of prevention“It’s important to follow a four-step process to protect against tick bites and prevent tick-borne diseases,” says Dr. Mather.

4. Kill ticks by spraying the perimeter of your yard.

• Hireaprofessionalcompanyrather than doing it yourself.

• Ifthedeerpopulationishighin your neighborhood, consider fencing or other barriers, and don’t feed them.

For more information, visit the TERC at TickEncounter.org.

3. Use appropriate tick repellent on clothing. • Alwaysuserepellentswithpermethrintotreatclothingbefore

venturing outside, or purchase clothing with permethrin tick repellent built in. Clothing treatment lasts through several washes. Remember to treat shoes and socks since tiny nymphal deer ticks are in the leaves on the ground and can crawl up.

• Foraddedprotection,youmaywanttotreatexposed skin (except the face) with an insect repellent containing 20-30 percent DEET. (Don’t use DEET on infants, and use it sparingly on children.)

1. Use pointed tweezers for safe tick removal.

2. Thoroughly inspect your body and clothes. • Carefullycheckyourclothes,skin,andscalpfor

ticks after being outdoors. Check children (and pets) as well.

• Ifyoucan’tavoidbrush-covered,woody,ortall grassy areas, try to stay in the middle of the trail away from brush, tall grass, and leaf litter.

• Chooselight-coloredclothingtoeasilyspotticks.

• Wearahat,longpantsandshirts,andclosedshoes.

• Tuckyourshirtin,andtuckyourpantsinyoursocksorshoes.

Real deer ticks are only the size of a sesame seed!


Serves four

ingredients

4 salmon filets, 4 ounces each

2 oranges, peeled, sectioned, and cut into bite-size pieces

1 cup canned pineapple tidbits, undrained

1/2 cup diced fresh mango

2 jalapeño peppers, seeded and minced

6 Tbsps. orange juice

2 Tbsps. diced red bell pepper

4 tsps. sugar

2 Tbsps. chopped fresh cilantro

instructions 1. In a bowl, combine all ingredients except salmon to make the citrus salsa. If you want a little less heat, use only one jalapeño. Refrigerate the salsa before using.

2. Scrub the grill rack clean with a wire brush, and then rub with a small amount of canola oil. This will prevent the fish from sticking. The grill is ready when you can only hold your hand four inches from the grill for no more than three or four seconds.

3. Salmon doesn’t need a lot of flavor added, so just rub a little olive oil into the fish, and season with salt and pepper. Leave the skin on, because this will help the fish stay together.

4. Turn your grill down to low, and put the fish on, flesh side down. Cooking times vary, but a one-inch thick filet will cook in about 8 minutes. Close the hood on your grill, and don’t open it again until you’re ready to flip it halfway through.

5. The fish is ready when it flakes up easily with a fork. Carefully remove the fish with a thin spatula. Some skin may stick to the rack, so make sure you clean the grill once you’re done cooking.

Pick your fishReady to grill? Follow these tips for picking the freshest fish:

Smell it. Fish should not have a pungent aroma, especially fillets.

Touch it. If the fish is packaged, press your finger into it. (If it is unpackaged, ask the person selling the fish to do so.) The indent should disappear.

Look at it. Is there any liquid on the fish? If so, it should be clear, not milky. Milky liquid is the

first sign of rot. If you’re buying a whole fish, the scales should be bright and metallic, the eyes should be clear, and the gills should be bright red. If choosing a fillet, avoid any with dark-ening or drying around the edges.

The wonder foodThe American Heart Association and the U.S. Department of Agriculture recommend eating fish twice a week. Low in fat and high in protein, fish contains important nutrients, including:

• Omega-3 fatty acids, which help reduce your risk of heart disease, rheumatoid arthritis, and depression. Certain fish—such as salmon, tuna, and herring—are much higher in omega-3s than other seafood. One omega-3 fatty acid, DHA, is also beneficial to the brain development of infants.

• Calcium and other minerals

• Vitamin B2, which helps your body use amino acids, fatty acids, and carbohydrates

• Vitamin D, which helps keep your bones strong and prevents osteoporosis

Although nearly all fish and shellfish contain traces of mercury, the risk from eating fish is not a health concern for most people, according to the Food and Drug Administration. However, certain types of fish or shellfish should be avoided by women who are or may become pregnant, nursing mothers, and young children. For more information, please visit cfsan.fda.gov/seafood1.html.

Grill up an easy summer supper with this salmon recipe.by Patrick Carney

Looking for a quick, healthy, and delicious summer supper?

Try grilling fish. Whether you choose salmon, halibut, tuna,

bass, or another variety, here are the basics for choosing,

preparing, and grilling fish. and be sure to try our recipe

for grilled salmon with citrus salsa.

Mahi mahi with lemon juice, olive oil, thyme, and rosemary

Rainbow trout with soy sauce, honey, balsamic vinegar, garlic, and olive oil

Bass with sundried tomato spread and capers

Halibut with lime juice, olive oil, parsley, cilantro, garlic, and jalapeños

Tuna with teriyaki, olive oil, and garlic

5 more ways to dress fish for grilling

Hook, Line, &Dinner

Grilled salmon with citrus salsaOne popular fish for grilling is salmon, which is loaded with heart-healthy omega-3 fatty acids. Here’s a quick, easy recipe for grilled salmon with citrus salsa. Serve it with wild rice and grilled vegeta-bles. you can use the grilling instructions to make just about any fish, although you may need to adjust cooking times depending on its thickness.

Phot

os b

y Pa

tric

k O

’Con

nor


The Ultimate Comfort Food?If you consider yourself a “chocoholic,” you’re not alone. Chocolate is the number one most craved food, especially for women. But why? Some researchers suggest that chocolate has addictive properties. It contains a variety of chemicals, such as phenylethylamine, that promote a good feeling in the brain and elevate your mood. Others claim it’s the melt-in-your-mouth feeling and the decadent taste that keeps you wanting more.

Whatever the reason, chocolate is definitely something you should have in moderation. Next time you feel the urge, try going for a walk, brushing your teeth, or if you just can’t resist, indulge in a small piece of dark chocolate. High in disease-fighting antioxidants, dark chocolate can help lower blood pressure and cholesterol.

WOmenYour Choices

5 Reasons to Read MoreThere’s been a lot of talk lately about how to keep your body healthy and fit. But what about your mind? One of the best ways to give your brain a workout is curling up with a good book. Here are just five reasons to make reading part of your healthy lifestyle:

1. it’s exercise for your mind. Reading provides active stimulation for your brain, which helps you stay mentally sharp.

2. it’s relaxing. Reading is a wonderful way to relieve everyday stress, and “get away from it all” for a while.

3. it makes you smarter. Reading helps you expand your vocabulary, learn new things, and spark your creativity.

4. it’s a great form of entertainment. Unlike passive activities like watching TV or a movie, reading lets your imagination take flight.

5. it brings people together. Reading is a great way to connect with friends, or make new ones, through a common experience. Reading to children is one of the best ways to engage kids for a lifetime of learning.

menYour Choices

a Runner’s Best FriendRunning with your dog can be great exercise for both of you. Like humans, dogs are born to move, and, like humans, most don’t get nearly enough exercise.

As with your own exercise program, it’s important to start slow at first. If your dog has been lying on the couch for hours on end, it’s not healthy to expect him or her to run miles with you. So start

with short distances at slower speeds, and then work your way up. Keep an eye on your dog while

you run, and slow down if he or she starts to lag behind or pant excessively. Also, start out by

running with your dog on soft surfaces—such as dirt, sand, or grass—until his or

her paws toughen up. (Wherever you run, be sure to follow leash laws.)

Going for a run with your dog will strengthen both your body and your bond with your dog. And once you establish a running routine, your dog’s enthusiasm will help keep

you motivated.

Get Back in the GameHas an injury kept you out of the game or the gym lately? That can be tough, especially if you’ve gotten into the groove of playing or exercising regularly. But as much as you want to get out there, it’s important to hold back until you get your doctor’s approval and are completely healed. Jumping back in too soon can turn a minor injury into a major one, and keep you on the bench even longer.

But even though you can’t do the activity you love, you don’t have to mope on the couch. Ask your doctor if there’s another exercise or activity that won’t aggravate your injury. Swimming, for example, is a great low-impact activity. (For more infor-mation on swimming, please see page 8.)

If you’re impatient to get back into your routine, look for these signs that you’re almost ready:

» The injury stops hurting, and/or is no longer swollen.

» You have full range of motion.

» Your injured limb or area is almost back to full strength.

» You can move with proper form, and/or without limping.

If your injury isn’t healing, or if you’re unsure about resuming your regular exercise program, talk to your doctor.

a Growing Problem

according to the american academy of Dermatology, about 30 million women in the United States experience alopecia, the medical term for excessive or abnormal hair loss. Unlike men, where about 90

percent of all cases are caused by heredi-tary male pattern baldness, female hair loss can result from genetics or a variety of other conditions.

Genetics – About 30 to 40 percent of female hair loss is inherited. During a normal growth cycle, a hair grows at the rate of about a half inch per month for a number of years. After a brief resting phase, the hair falls out, and a new hair starts to grow from the follicle. Some women have a genetic sensitivity to certain hormones called androgens, which interrupts this cycle. Over time, the androgens cause the hair follicle to shrink and become unable to grow new hair.

Other causes – A number of other conditions can affect hair growth in women. In many cases, treating the cause will result in hair growing back on its own.

» Changes in hormone levels following childbirth, when taking birth control pills, or during menstrual cycles and menopause

» Polycystic ovary syndrome, a hormonal problem

» Certain types of autoimmune disorders, such as alopecia areata, an inflammatory condition that can cause hair to fall out in clumps or patches

» Temporary hair loss, which can occur following crash dieting, surgery, or a traumatic emotional event

» Thyroid disorders, anemia, chronic illness, chemo-therapy, stress, and certain medications

If you’re experiencing hair loss, talk to your doctor. Finding the cause is the first step in getting the right treatment. For more information, visit American Hair Loss Council at ahlc.org.

around the FireLast March, a Florida campfire resulted in a wildfire that burned more than 6,000 acres. Campfires are one of the leading causes of wildfires, so put safety first when you’re under the stars:

» Find out if your campsite allows campfires. Some sites don’t allow them at all, others limit fires to existing fire pits.

» If your campsite already has a fire pit lined with rocks, use that instead of building a new one.

» If you’re building a fire pit, keep it away from slopes, rotten stumps, dry grass, and leaves.

» Keep plenty of water and a shovel nearby. Use both water and dirt to put out a fire that gets out of control.

» Don’t let the fire grow too big or too fast. Start with twigs and smaller sticks, and then add larger pieces of wood as the flame grows.

» Never leave the fire unattended.

» When it’s time to put the fire out, smother it with water, stir it up, and smother again. Make sure you’ve turned over any remaining embers or wood, as the fire can still smolder on the flip side.


CHilDren Your Choices Leave Fireworks

to the ExpertsFireworks will probably be part of your Fourth of July plans. Many people still choose to light their own, despite the fact that they’re illegal in many states (including Rhode Island). Every year in the United States there are more than 9,000 fireworks-related injuries—mostly burns and eye injuries—almost half to children under the age of 15. The safest option is to leave it to the professionals, and attend a public fireworks display. That will ensure a safe and happy holiday for everyone!

OlDer ADulTS Your Choices

a Driving Checkupas you grow older, your driving skills

may be affected by changes in your vision, hearing, mobility, memory, and medications.

While some people at 70 or 80 may be more than capable behind the wheel, others struggle to read road signs, don’t react quickly to sudden road changes, or don’t hear car horns, emer-gency vehicle sirens, or other warning signs.

But how can you know if your driving is becoming unsafe? The National Highway Traffic Safety Administration (NHTSA) recommends asking if any of the following has happened to you:

• A friend or family member has expressed concern about your driving.

• You sometimes get lost while driving on routes that were once familiar.

• You have been pulled over by a police officer and warned about your poor driving behavior, even if you didn’t get a ticket.

• You have had several moving violations, near misses, or actual crashes in the last three years.

• Your doctor or other health caregiver has advised you to restrict or stop driving.

Older drivers have higher rates of fatal crashes, based on miles driven, than any other group except very young drivers. That’s why it’s so important to talk to your doctor about how your physical limitations and medications may be affecting your driving. It’s also important to talk to your family and friends as well as learn about—and try out—other transportation options in your community. For more informa-tion on aging and driving safety, please visit nhtsa.dot.gov.

11 Ways to FlavorGrilled tomatoes with fresh basil. Chicken stir-fry with paprika. adding herbs and spices to your meals is a great way to increase the flavor—and decrease the salt—in your meals. Here’s a look at some delicious additions to your meals.

1. Follow the guidelines of the American Academy of Pediatrics, which recommends that children under 12 not be allowed to use a push mower, and children under 16 not be allowed to use a riding mower.

2. Explain to children that lawn mowers are not toys, and that they can be dangerous.

3. Know where children are when you’re mowing the lawn. Better yet, keep children in the house if possible.

4. Don’t give children rides on a riding mower—they can fall off and get hit by the blades. Nearly half of all lawn mower injuries are caused this way.

5. Disengage the blade when backing up.

No More Mower Ridesyou may be tempted to have your children mow the lawn for you this summer, or sit with you on your riding mower, but doing so may be more dangerous than you realize. It’s estimated that lawn mowers cause more than 10,000 injuries to children each year, many of them serious and life-altering. Here are five ways to minimize the chance of an accident:

HErB/sPicE Try with

Basil Tomatoes, eggplant, zucchini, stir-fries, cheese, pasta, soups, salads, eggs

cayenne pepper

Beans, stir-fries, salsa, guacamole, meat marinades or rubs, Latin American meals

chives Potatoes, soups, eggs, salads, fish

cilantro (coriander)

Poultry, fish, rice, salsa, stir-fries, and Latin American, Asian, and Middle Eastern dishes

dill Green beans, peas, asparagus, yogurt, fish, chicken, eggs, tuna salad

Marjoram Brussels sprouts, peas, broccoli, poultry, fish, lamb, eggs, cheese, Middle Eastern dishes

Mint Berries, melon, lamb, yogurt, salads, soup, Middle Eastern and Asian dishes

Paprika Poultry, fish, beef, stew, potatoes, eggs, rice, casseroles

rosemary Roasted vegetables, potatoes, poultry, lamb, pasta sauce, pizza

sage Squash, apples, root vegetables, beans, tomato sauce, poultry, fish

Thyme Carrots, peas, tomatoes, beans, eggs, fish, poultry, soups

Note: Some spices not listed here—such as garlic, onion, and celery salts, and lemon pepper—contain added salt.

The aBCs of Crib SafetyBabies spend a majority of their time sleeping. So it’s important that you make their crib a comfortable, safe place, espe-cially for those under 12 months of age. These tips can help you make the crib as safe as possible for your baby:

Good Health, Good TimesLooking for some interesting, fun, and healthy ideas to keep the kids busy this summer? These Web sites are jam-packed with ideas for healthy activities, experi-ments, fun facts, and more to get your kids excited about being healthy!

Kidnetic.com – Designed for kids aged 9 to 12, their parents, and teachers, this site contains ideas to help kids develop healthy lifestyles. This includes games and physical activities, healthy recipes, and information on how the body works.

Kids.gov – This is the U.S. government’s site for kids in grades kindergarten through eight, as well as educators. Find hundreds of links to educational and fun government, nonprofit, and commercial Web sites for kids.

KidsHealth.org – KidsHealth.org is the most visited U.S. Web site for health, behavioral, and developmental information for kids from babies to teens. Look for comprehensive sections for younger children, teens, and parents.

actionforhealthykids.org – This site is dedicated to providing parents and teachers with great ideas to get kids “off the couch.” It includes ideas on how to be a physically active family and toolkits for wellness challenges.

» Use a firm, tight-fitting mattress that doesn’t have any space between it and the crib.

» Don’t put pillows, comforters, blankets, bumper pads, or stuffed toys in the crib, as they can all suffocate the baby.

» Only use a fitted sheet for the mattress, one made specifically for crib use.

» Choose a crib with slats that are no more than 23/8 inches apart. Anything wider can trap an infant’s head.

» Ensure the crib is assembled correctly, and that there are no broken slats (or slats with splin-ters) or loose/broken hardware.

» Place the crib away from windows—cords from window blinds can be dangerous.

» Check for crib recalls. A good place to start is cpsc.gov, the U.S. Consumer Product Safety Commission Web site.

For more on these and other choices, visit

Your choices affect your healthcare costs. Often it’s the everyday small choices that affect the big picture.

A healthier diet is just one way you can keep yourself well.

sponsored by Blue Cross & Blue Shield of Rhode IslandBlue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association.

32 SUMMER 2009

Picture of Health

Photo by Joel Marion Photography

We’re looking for people of all ages, conditions, and abilities to be featured in “Picture of Health.” If you know someone who has chosen to take charge of his or her health by exer-cising, eating right, and getting regular checkups, we’d like to know! Send us a letter describing why the person you’re nominating should be featured, along with a recent photo.

E-mail your submission to [email protected] or mail it to:

“Picture of Health” Choices MagazineBlue Cross & Blue Shield of Rhode Island 444 Westminster Street, Providence, RI 02903

Tiffani KiernanSt. Louis, Missouri

When it comes to exercising, most of us need a little help staying motivated. That’s why it helps to know someone like Tiffani Kiernan. Nearly every day at lunch, Tiffani exercises at a gym near her job at American Power Conversion—and she invites her colleagues along. She even organizes a carpool for employees who work out at lunch, and lets her coworkers know about new classes being offered. “After I had my daughter, I joined a gym,” Tiffani says. “Now I absolutely love going. I have so much more energy, and I don’t have the back pain I used to.” Plus, she says, the people at the gym become a “little extended family.”

What is your favorite exercise?“The strength training classes. I see a huge difference in my arms and legs.”

What is your favorite place to exercise?“The gym right down the street from work.”

What are your favorite healthy foods?“I really love Greek salads and sushi.”

What are your words to live by?“You only live once, so make every day count.”

The board and staff of the American Red Cross Rhode Island Chapter wish to express our sincere gratitude to all the individuals, small businesses, and corporations who helped make our 2009 Heroes for the Red Cross campaign a success.

Thanks to your generosity, we have raised over $25,000.

These funds will be used to provide food, clothing, and shelter to Rhode Islanders who experience a house fire or other disaster.

Same fruit. Different results.

You’re a dad. You’re a teacher. But, to her, you’re so much more. Choose the health plan that is, too. As parents, we’re always there for our families. At Blue Cross & Blue Shield of Rhode Island, we share that same commitment to all of our members. That’s why we provide such a wide range of coverage options. We’re committed to giving our members access to the best healthcare available through the largest provider network, and a wide array of health resources and programs.

Healthcare coverage that’s best for your family, and helps you be you, that’s Blue Cross & Blue Shield of Rhode Island.

Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association.Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association.

Blue Cross & Blue Shield of Rhode Island444 Westminster Street Providence, RI 02903

PRSRT STDAUTO

U.S. POSTAGEPAID

GLASGOW, KYPERMIT #990

easy summer grilling · author, mindless eating: why we eat more than we think 4 health briefs the...

Documents