Andrea Hooten

Family Medicine Conference Warns of Trend for Early-Onset Colorectal Cancer and Highlights Topics Important to Family Medicine

Family medicine providers gathered for UAMS’ virtual 2025 Family Medicine Spring Review April 23 -25 and learned that the colorectal cancer death rate in people younger than 55 is climbing one percent each year since the mid-2000s, but that this group is more open to a yearly stool-based screening test such as the fecal immunochemical test (FIT) or Cologuard than other age groups.

The colorectal cancer screenings updates from Whitney Jones, M.D., a gastroenterologist from Kentucky, and Francis Colangelo, M.D., a primary care physician with Allegheny Health Care in Pittsburgh, were part of the first day of the three-day conference.

Francis Colangelo, M.D., primary care physician, speaking on early-onset colorectal cancer.

“Around 41 percent of these (younger patients) had symptoms for at least six months before visiting a provider,” said Colangelo. “And if you see rectal bleeding, always assume it is colorectal cancer in the younger patient.”

The conference was presented by the Department of Family and Preventive Medicine’s Community Health and Education division, which has produced continuing medical education for 47 years.

Amanda Deel, D.O., associate dean of the New York Institute of Technology’s College of Osteopathic Medicine, spoke on compassion in healthcare.

“Following a compassion-centered script with patients may feel artificial, but in a study, patients didn’t sense that. Physicians miss opportunities to practice compassion 70 percent of the time and interrupt patients on average in the first 11 seconds,” said Deel.

Angela Driskill, M.D., is a wound care specialist practicing at Baptist Health. She said there must be a distinction between pressure injuries and skin that fails because pressure injuries imply failure of care or harm.

“If you don’t document a wound 12 to 24 hours after admission, it will throw up a red flag to CMS. Say it’s been 24 hours before anyone does a skin assessment, they are classified as ‘unwounded’ when they came in. Then we document there’s a stage 3 or 4 wound of the sacrum, and CMS begins to recoup the cost of that care, which can be $50,000 to $70,000,” said Driskill.

Sleep medicine physician Caris Fitzgerald, M.D., offered trouble-shooting tips for patients who wear a CPAP, a machine that treats sleep apnea with continuous positive airway pressure. CPAP manufacturers estimate that more than eight million people wear a CPAP each night. One common complaint is dry mouth.

Picture of Caris Fitzgerald, MD — **Caris Fitzgerald, M.D.**

“A leak makes or breaks the experience with a CPAP,” said Fitzgerald, who sees patients at the Central Arkansas Veterans Healthcare System. “If a patient complains of dryness, fix the leak, don’t just increase the humidity. The nose is a humidifier. If your pressure system is sealed well and the patient is nasal breathing, they will not need a humidifier.”

My goal with patients is 10LPM unintended leak. 10LPM is generally a good goal for 95% Unintended Leak. Most under 10LPM can do without a humidifier which means a lot less cleaning and expense. And those with co-occurring good use have almost always resolved the complaints associated with OSA.

In his talk on metabolic issues, James Tucker, M.D., bariatric surgeon with Arkansas Heart Hospital, said bariatric surgery is not a cure for disease of obesity but a treatment. Sleeve gastrectomy is the more common surgery where 50 to 70 percent of the stomach is removed.

“With insulin-dependent patients who’ve had the surgery, 60 percent to 80 percent experience remission from the disease,” said Tucker.

On the third day of the conference, Amy Grooms, M.D., with the UAMS Department of Psychiatry, spoke about using transcranial magnetic stimulation for patients with treatment-resistant depression. She said transcranial magnetic stimulation uses a magnetic pulse that stimulates the dorsolateral prefrontal cortex and rebalances it with the subgenual anterior cingulate cortex. Around 30 percent of patients who use this treatment have a standard response, but 18 percent of patients report that their depression is gone.

Bill Fantegrossi, Ph.D, who works in the UAMS Department of Pharmacology and Toxicology, ended the conference with a talk on emerging drugs of abuse. He said new synthetic opioids grip more tightly to the opioid receptors in the brain. With such a strong bond, reversing an overdose is difficult with standard treatments such as naloxone (Narcan). Naloxone knocks opioids from brain receptors, but it struggles to unbind new synthetic opioids from receptors. This means it can only partially reverse an overdose or may fail.

Synthetics - fentanyls. Lethal doses of heroin, fentanyl and the ultra-potent analog carfentanyl.

Other conference topics included an update on the HPV vaccine with Portia Knowlton, who works with St. Jude’s HPV prevention program, renal cysts and masses with UAMS’ Marcelo Bigarella, M.D., and long-term effects after curative cancer treatments with Viriginia Laliberte, APRN. Ashley Acheson, Ph.D., and Jami Jones, who work with the National Center for Opioid Research & Clinical Effectiveness at Arkansas Children’s Hospital, spoke on the research they are conducting on children and adolescents who have been affected by the opioid crisis and other drug addictions.

Virtual Family Medicine Update Set for Oct. 23 – 25 with First Day on Opioids

Family Medicine Update, Fueling the Front Line, Oct. 23 - 25

The 28th Annual Family Medicine Update: Fueling the Front Line will offer up to 14 hours of online CME/CE Oct. 23–25 for primary care physicians, doctors of osteopathic medicine, advanced practice registered nurses, registered nurses, pharmacists, physician assistants, physical therapists, certified health educators, social workers and substance abuse counselors.

To register, visit https://cvent.me/4X75nd or call 501-686-6626 by Oct. 21.

The annual conference provides an opportunity for health care professionals to learn about the latest advances and information impacting family medicine.

The conference is completely virtual. The first day – All About Opioids – offers six hours of content for only $25. Thursday and Friday sessions are $20 each.

The first day is All About Opioids with talks from local and national experts on opioids, kicking off with Don Teater, M.D. He is a family physician from Denver who has focused on the intersection of pain, opioids and addiction and was medical advisor for the National Safety Council. Another nationally known speaker, Aaron Weiner, Ph.D., will offer ways providers can help those with substance use disorders when abstinence isn’t an option. A team from Boston Mountain Rural Health will give a behind-the-scenes look at how they integrated behavioral health into their clinics to help those with addiction and co-occurring mental disorders. Other speakers include Karen Burks, M.D., a family physician with the UAMS/Baptist Health family medicine residency program, and UAMS’ Bill Fantegrossi, Ph.D., who researches new psychoactive substances such as “bath salts” psychostimulants to amphetamine-like dietary supplements. Kristin Martin, D.O., founder of River Valley Medical Wellness, is bringing her team to talk about their mobile opioid recovery unit which treats patients with substance use disorder in areas where help is scarce.

Talks on the second day will feature topics from UAMS providers on non-alcoholic fatty liver disease with Sheena Colclough, APRN, a syphilis update with Mitchell Jenkins, M.D., chronic kidney disease with Paige Beck, M.D., Ph.D., and Cassandra Fritz, M.D., an assistant professor with Washington University Medicine’s division of gastroenterology, who will speak on early onset colorectal cancer.

The third day of the virtual conference will focus on weight loss medications, presented by Bri Morris, Pharm.D., executive director of the Arkansas Community Pharmacy Enhanced Services Network, and UAMS’ Christopher Johnson, Pharm.D. Patty Harper, CEO of InQuiseek Consulting, will update attendees on Medicare news. The two afternoon sessions will feature pulmonary and cardiology updates with Steven Deas, M.D., a physician with the Central Arkansas Veterans Healthcare System, and UAMS’ Srikanth Vallurupalli, M.D.

**Pharmacists Christopher Johnson and Bri Morris**

Participants who attend the entire conference and complete all surveys will be eligible to attend the Family Medicine Spring Review in April at no cost.

Hidradenitis Suppurativa: Three Questions to Diagnose and Five Layers of Treatment

Hidradenitis suppurativa (HS) is a skin disorder that starts with blocked hair follicles, leading to painful nodules, abscesses and scarring. Front-line providers can work with dermatologists to diagnose and treat this often debilitating condition by asking three questions and following a five-tiered approach to treatment.

Dr. Vivian Shi, former UAMS dermatologist and director of the hidradenitis suppurativa clinic, offered tips to family medicine providers at the UAMS 2024 Family Medicine Spring Review last April. She said, “It requires a multidisciplinary approach. An HS team including all of these specialists and dermatology providers are the principal providers, but we really lean on front-line providers … to detect, treat, refer and to collaboratively manage.”

Picture of Vivian Shi, MD — Vivian Shi, M.D.

Most of her HS patients have had it more than 10 years after having seen their providers at least five times, and around 15% are disabled or unable to work because of HS pain. Girls typically show signs in their early teens, and boys start in their mid to late teens. If the teen has severe acne, have the patient lift the arms to check for HS signs. The typical onset is between puberty and age 40, with women being three times more likely to be affected.

Three key diagnostic questions every provider must ask the patient:

1. In the last 12 months, did you repeatedly have big, painful nodules and boils in the armpits or groin?

2. Have you had outbreaks of boils in the last six months?

3. Do you repeatedly have outbreaks of big sores, painful nodules or boils that heal with scars in any of these locations?

If the answer is “yes,” there is a 90 percent chance of HS.

“There’s no reason healthcare providers should be missing this if they ask these questions,” said Dr. Shi.

HS can show up anywhere on the body – behind the ears, outer arms or legs – not just the skin folds and areas with sweat glands. The two exceptions are the palms and soles of the feet. It’s chronic, inflammatory and very painful. Initially, the patient will have inflamed nodules, abscesses, white heads and black heads. The more advanced stage includes draining sinus tracts (narrow channels) and severe scarring, which are especially true in Blacks. Often it is misdiagnosed as cellulitis.

HS is divided into three Hurley Stages. The mildest is Hurley Stage 1: Abscesses that resolve without any trace of scarring, but this is rare. As soon as the patient has any sign of a scar, it’s labeled Hurley Stage 2. This stage includes recurrent abscesses, sinus tracts and scarring, but normal-looking skin will appear between them. The most advanced stage is Hurley 3, characterized by multiple connected sinus tracts and abscesses across the entire area with little to no normal-looking skin between. She describes it as an “over-exaggerated inflammatory response where, over time, the hair follicles connect with each other and form sinus tracts and extensive scarring.”

Dr. Shi recommended a pyramid of treatment. The front-line provider can manage all the treatments except for biologics, the top tier. In early moderate to severe patients (late Hurley 1 to early Hurley 2), Dr. Shi suggested preparing patients for biologic therapy by prescribing oral antibiotics because payors typically require patients to fail 90-plus days of systemic antibiotics to qualify. Regardless of disease stage, providers should refer the patient to a dermatologist for advanced therapy, while collaboratively managing the patient.

The 5 Tiers of Treatment:
Top layer - Biologics
Second layer - Hormonal Treatments
Third layer - Oral Antibiotics
Fourth layer - Topicals
Bottom Layer - Lifestyle Modification

Lifestyle Modification

The first tier of the pyramid is lifestyle modifications where the provider would screen for comorbidities and start treatments. In a recent JAMA Dermatology report, patients with HS said diet changes were the most used non-prescription treatment with the Mediterranean diet and intermittent fasting both being effective. The two exercises that HS patients can tolerate are Pilates and swimming. Weight loss surgery is also a strong consideration if the patient is greater than 35 BMI, and if the patient smokes, encourage them to quit since cigarette smoke has dioxin-like compounds that can cause acne and scarring. Loose-fitting clothing and anti-chaffing products applied in skin folds can reduce friction and pain.

If the patient has draining sinus tracts, bathing helps to rinse out the tunnels. Dr. Shi recommends alternating daily with 10-minute baths of Epsom salt, CBD oil and ¼ cup 6% commercial bleach which help with pain, itch, relaxation and decrease biofilm.

Topicals

The next level is topical treatments. She typically uses clindamycin 1%; however, resorcinol 15% elicits a better response in mild to moderate HS. Resorcinol is especially helpful because it breaks down the outer layers of the skin and unplugs the hair follicles. There are also washes such as benzoyl peroxide, chlorhexidine or dapsone. Dr. Shi cautioned against benzoyl peroxide wash used together with topical dapsone because they’ll have reversible yellowing of the hair follicles.

Oral Antibiotics

Dr. Shi’s office typically starts with the tetracycline family because it’s better at reducing inflammation in the hair follicle and less costly. She recommends 100 milligrams of doxycycline or minocycline twice daily or extended release minocycline at a weight-adjusted dose once a day for eight to 12 weeks. Dr. Shi cautioned that dosage may need to exceed 100 milligrams for it to work, so ensure the patient doesn’t have anemia. She uses this for flare-ups or to bridge to biologic therapy.

Rotating through combined systemic antibiotics also works, being careful not to extend beyond three months. One combination is clindamycin with rifampin. A second choice is rifampin with moxifloxacin and metronidazole, which is especially helpful for drainage. And one thing providers want to consider is to stop the metronidazole after six weeks because longer use can cause reversible peripheral neuropathy.

Certain supplements also should be considered. Persons with HS typically have lower serum zinc levels. Prescribing 100 – 200 milligrams of daily zinc (with copper included after two months) has shown to reduce HS severity in 80% of patients. Another supplement to consider is Vitamin D since most patients with HS are deficient. Vitamin D regulates hair cycle and skin cell activity.

Hormonal Treatments

Dr. Shi recommends these hormonal / metabolic therapies:

Hormonal and Metabolic Therapies
For Women - Spironolactone 50 - 150 mg daily. Monophasic OCP (with increased estrogen and with anti-androgenic progestin such as drospirenone)
For Men -- Finasteride 5-10 mg daily
For Both - Metformin 500 mg - 1500 mg daily (for patients who are obese or have diabetes). Also Metformin XR.

Biologics
Biologics is the last step of treatment. Dr. Shi said providers should learn the basics of biologics so they can explain how it works before they refer to a dermatologist. The patient must be on at least 90 days of an oral antibiotic before most insurance will allow biologics.

Dr. Shi’s takeaways:

Ask the three questions to have a high confidence of diagnosing HS.

Refer to dermatology once diagnosed.

Screen for metabolic syndromes, inflammatory bowel disease, hormonal and mental health abnormalities.

Reverse screen for HS if the patient has Down syndrome.

Start antibiotics if the patient has any scarring because biologics is the next step. Most insurance requires 90 days to four months of oral antibiotic to be eligible for biologic treatment, so this is the referral window.

More information on HS can be found at hs-foundation.org

If you’re interested in more of UAMS’ primary care CME/CE, check out our list of upcoming CME/CE here.

Virtual Family Medicine Spring Review Set for April 24 – 26

Family Medicine Update April 24 - 26, 2024

The 2024 Family Medicine Spring Review will offer up to 14.5 hours of online continuing education April 24 – 26 for family physicians, advanced practice registered nurses, registered nurses, pharmacists, physician assistants, physical therapists, social workers and certified health educators.

The annual conference provides an opportunity for health care professionals to learn about the latest advances and information impacting family medicine.

The conference is completely virtual. Courses are offered in two-hour blocks, twice daily, at $40 per block. To register, visit https://cvent.me/Rw3P30 or call 501-686-6626.

Experts will discuss a variety of topics important for family medicine providers.

Leslye McGrath, M.D., recently named president of the Arkansas Academy of Family Physicians, will speak on “Family Medicine with Intention.” Additionally, three family medicine physicians will present “Recruiting and Retaining Family Medicine Doctors for Rural Arkansas.” They include Ronald Brimberry, M.D., professor at UAMS Northwest, Brad Walsh, M.D., program director for the UAMS Rural Track Program Family Medicine Residency in Crossett, and Donya Watson, M.D., physician with the South Arkansas Women’s Clinic in El Dorado.

Kristin Martin, D.O., and Patty Gibson, M.D., will co-present their efforts to integrate behavioral health at River Valley Medical Wellness in Russellville and across the state. Their talk will be woven in with the video “Integrated Care: The Weave of Addiction Recovery” produced by the Community Health and Education Division in partnership with UALR Midsouth.

Two talks related to skin issues will feature Angela Driskill, M.D., wound care specialist with Baptist Health, who will present best practices in treating bacterial skin infections, and Vivian Shi, M.D., who will discuss hidradenitis suppurativa management.

Skip Hoggard, a licensed therapist with Arkansas Children’s Hospital Center for Safe and Healthy Children, will talk about eating disorders.

Other talks include “Opioid Stewardship” with Jana Peairson, Pharm.D., and “Helping PCPs Help Patients and the Impact of Oral Health on Primary Care” with Ashley McMillan, DDS, associate professor at UAMS’ Delta Dental of Arkansas Foundation Oral Health Clinic.

Friday will feature national experts discussing the latest in tobacco use, e-cigarettes, cannabis, mindfulness-based interventions to motivate smoking cessation, lung cancer screening and identifying tobacco-related inequities.

Virtual Family Medicine Conference Oct. 24-27 Offers Up to 18 Hours of Content

UAMS’ 27th Annual Family Medicine Update with Tobacco & Disease Symposium will offer up to 18 hours of online continuing education Oct. 24–27, 2023, for primary care physicians, doctors of osteopathic medicine, advanced practice registered nurses, registered nurses, pharmacists, physician assistants, physical therapists, respiratory therapists and certified health educators.

Presented by the UAMS College of Medicine, the annual conference provides an opportunity for health care professionals to learn about the latest advances and information impacting family medicine.

Pilar Murphy, Pharm.D., has the latest updates on pharmacology for heart failure.

The conference is completely virtual. Courses are offered in two-hour blocks, twice daily, at $40 per block, with sessions on Friday, Oct. 27, at no cost. Friday’s session offers three, two-hour blocks of content.

To register, visit https://cvent.me/nRD90O or call 501-686-6626 by Oct. 23.

Several talks on cardiovascular issues will feature Andre Ramdon, M.D., who will speak on peripheral arterial disease and aortic aneurysms, and pharmacist Pilar Murphy will speak on the pharmacology to treat heart failure.

Lester Matlock, CFP, will offer practice tips for providers with his talk on “Work Until You Drop,” and physical therapist Andy Glidewell will give practical physical therapy pointers that providers can use in their practice.

Two experts will speak on opioid issues. Michael Mancino, M.D., professor at the UAMS Psychiatric Research Institute and program director for the Center for Addiction Services and Treatment, will discuss treating Opioid Use Disorder in primary care. Karen Burks, M.D., a family physician, will also be speaking on opioid use and prescribing.

Dr. Michael Mancino — Michael Mancino, M.D., will speak on Opioid Use Disorder

The block on “Cravings to Consequences” will feature a talk on eating disorders with Laura Jones, APRN, who works with adolescents at Arkansas Children’s Hospital, and Elizabeth Cleveland, Ph.D., is slated to talk on fetal alcohol syndrome disorder.

Other topics include maternal depression with Nikki Edge, Ph.D., and Shashank Kraleti, M.D., chair of the UAMS Department of Family and Preventive Medicine, and young onset colorectal cancer with Smita Krishnamurthi, M.D., with the Cleveland Clinic’s Department of Hematology and Oncology.

Friday will be dedicated to the Tobacco & Disease Symposium with talks centered on tobacco cessation strategies, talking to patients about quitting tobacco and how tobacco/nicotine products are engineered to be more addictive.

Symposium speakers include Emily Einstein, Ph.D., chief of science policy at the National Institute on Drug Abuse, who will talk on topics for teens regarding tobacco, alcohol and drug use; Aaron Weiner, Ph.D., owner of Bridge Forward Group; and Angela Criswell, M.A., director for GO2 for Lung Cancer, whose talk will focus on lung cancer screening as part of tobacco cessation.

Crafton Tull, SPAN Win Regional Award for US Bike Route 80

Dave Roberts & Julie Kelso with Crafton Tull and Leesa Freasier with SPAN hold up award — Dave Roberts and Julie Kelso with Crafton Tull flank Leesa Freasier with SPAN

A team from Crafton Tull, State Physical Activity and Nutrition, Arkansas Department of Transportation, Metroplan and Arkansas Department of Parks, Recreation, Tourism and Heritage spent more than a year studying potential routes for the US Bike Route 80 in eastern Arkansas.

The American Society of Landscape Architects Central States recently awarded planning firm Crafton Tull a merit award for its 113-page U.S. Bike Route 80 feasibility study, competing with 100 submissions from eight states. The bicycle route, which connects central Arkansas to the Tennessee border, covers 177 miles of rural byways. UAMS’ State Physical Activity and Nutrition grant from the Centers for Disease Control and Prevention collaborated on the study, evaluating towns along two proposed routes to see which one offered safer and better amenities for long-distance cycling.

The route starts in North Little Rock and meanders through England, Stuttgart, Clarendon, Marianna, Hughes, winding up in West Memphis. It was officially designated as U.S. Bike Route 80 in late 2022 by the Arkansas Department of Transportation.

A team made of up of Crafton Tull, SPAN, Arkansas Department of Transportation, Metroplan and Arkansas Department of Parks, Recreation, Tourism and Heritage began the feasibility study in 2018. The group made notes of city amenities such as health clinics, bike repair stations and cultural attractions which bicyclists would have interest in. They also kept notes on safety issues such as traffic volume, lane and shoulder widths.

The US Bike Route System is a national network of bicycle routes connecting urban and rural communities with signed roads and trails. U.S. Bicycle Routes direct bicyclists to a route through a city, county or state with new routes added each year. The U.S. Bike Route 80 will pull in more dollars from tourism and help economic development with the official designation.

Crafton Tull also won an award in 2021 from the American Planning Association’s Arkansas Chapter for “achievement in comprehensive plan design.”

Photos from US Bike Route 80 Feasibility Study

Two bike riders under trees covering roadway

Team members study wayfinding sign on route

Picture of bicyclist holding bike at Waverly Plantation

Physician Wins Award for High Colorectal Cancer Screening Rate

Dr. Clinton Smith with 1^st Choice Healthcare was named the Arkansas Cancer Coalition Healthcare Provider of the Year at the Arkansas Cancer Summit March 7 for his 75 percent rate of colorectal cancer screening with his patients.

The family physician has participated in the UAMS Partnerships in Colorectal Cancer Screening for Arkansas (PiCS-AR!) since 2020, a Centers for Disease Control and Prevention grant that seeks to raise colorectal cancer screening rates in the state. His 75 percent rate is closing in on the national goal of 80 percent set by the National Colorectal Cancer Roundtable.

Clinton Smith, DO, physician with 1st Choice Healthcare in Corning, Arkansas

Smith’s first year with the PiCS-AR! grant showed a screening rate of 65 percent. His rate grew to 70 percent in 2021 and has escalated in one year to 75 percent. He said the reasons for his higher screening rate stem from frequently reminding the patients of screening, making it easy for them to screen, and relaying the facts.

“Each time I have a checkup with a patient (not even necessarily a wellness checkup), I try to mention (screening) and see if they’re due for anything. And if they are, we try to go ahead and facilitate that and get it set up,” said Smith. “The best time to (mention) it, in my opinion, is when you see them. Sometimes people are non-compliant and you may not see them for a while. Now, it does take extra time, and sometimes I get behind, but I feel that prevention is the key. It’s better to prevent a problem than to have to treat it later.”

Smith gives his patients several screening options: stool-based tests and a colonoscopy. The stool-based tests (FIT or Cologuard) require that the patient send a sample of their stool in the mail, which takes minutes and is not invasive and requires no dieting, fasting or anesthesia. The colonoscopy is considered the most accurate for colorectal cancer screening, but with his rural patient population in northeast Arkansas, arranging a colonoscopy can be cost- and time-prohibitive.

“I tell them about the options and let them decide. I think the FIT tests have helped a lot. We’re rural, so to get a colonoscopy, you not only have to take a day off of work, you have to drive 30 miles outside of town,” said Smith.

Colorectal cancer is the second deadliest cancer for Americans, and it’s on the rise with younger age groups, according to the American Cancer Society. The rate of new colorectal cancer cases among Americans younger than 55 increased from 11 percent of all cases in 1995 to 20 percent in 2019. The recommended screening age for those with average risk is 45, which the U.S. Preventive Services Task Force lowered from age 50 two years ago because of this new trend. Screening at an earlier age means cancer will be caught in its first stage and is highly treatable if detected early.

Smith also credits his employer, 1^st Choice Healthcare, for allowing him to spend more time with his patients who are often chronically ill and require more than the suggested 15 minutes many physicians are tethered to. 1^st Choice is one of two healthcare partners working with the PiCS-AR! five-year grant. Mid-Delta Healthcare System in eastern Arkansas is the latest system to join.

Early Childhood Education Centers Use Grant Money to Make Rooms for Breastfeeding Moms

Leticia Rodriguez, director of the Lovely Sunshine Learning Center in Little Rock, has transformed a room in her childcare center into a place where staff and clients can feel comfortable breastfeeding or pumping breast milk, thanks to a $3,000 subgrant from the UAMS Department of Family and Preventive Medicine’s State Physical Activity and Nutrition for Arkansas (SPAN).

Before and After of Lovely Sunshine Breastfeeding Room — Lovely Sunshine Learning Center

Lovely Sunshine Learning Center is one of 15 early childcare centers that will receive the subgrants from SPAN, which is funded by the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity and Obesity. SPAN seeks to encourage breastfeeding in early childcare settings because research has shown that children who breastfeed six months or more may reduce their risk of obesity as well as severe asthma, SIDS, ear infections and some chronic diseases.

Rodriguez has used the money to buy two nursery swivel chairs, a colorful throw rug, mini-refrigerator, lamp with USB outlets, boppy pillow, bookshelf and framed pictures for décor. She also wants a drape that will separate the room so two mothers can privately breastfeed at the same time. SPAN will also supply milk storage bags, posters and pamphlets.

Sierra and her child Indigo no longer have to breastfeed in the reception area.

“I have a breastfeeding mom (parent of a student) and one staff member that breastfeed. My employee doesn’t care if anyone sees her breastfeed, but the mom was not comfortable in the room. She breastfed in the reception area which isn’t private because staff members and parents are always coming through,” said Rodriguez, who completed the room September 2022. “So far, the response has been good!”

Three other childcare centers have also received the funds, and moms have immediately begun using the made-over rooms. Bingham Road Baptist Child Development Center in Pulaski County took an unused infant room and gave it a breastfeeding makeover, complete with chair, rug, mini-refrigerator, décor and covers for moms as they breastfeed their babies. A staff member and new mom were quick to use the room, with the new mom saying, “It’s so great not having to feed in my car.”

Bingham Road Baptist Child Development Center

Tonya Ritter, director/coordinator for ABC Preschool at Heber Springs Elementary, has redone an unused office at the school with a soft chair, lamp, rug and mini-refrigerator. She plans to add a plant in the corner, brochure stand, framed landscapes for the walls and a shelf to house WIC information and a book about breastfeeding for children. Supplies for the moms are conveniently stored in a basket, and the room connects with the nurse’s office in case of issues.

“It has been used by a few who had to pump in their cars on their breaks,” Ritter said. “They are so appreciative. We have a few expectant mothers who are so excited to have a place to go rather than their cars.”

Heber Springs Elementary’s makeover of its breastfeeding room.

Another childcare center that used the grant money is Janna’s Little Angels in Little Rock. Lanna Horton, director, transformed a room for storage/staff into a light-filled, colorful breastfeeding space for her families. Two moms have started using it, and the center plans to add a refrigerator to store milk. A door connects to the infant classroom, so mothers will now have a space where they can visit on their breaks, a much better solution than the director’s office.

From storage space to breastfeeding room at Janna’s Little Angels

England, AR, Closer to Approving Master Bike and Pedestrian Plan

City Seeks to Encourage Physical Activity and Economic Development

England’s city council will discuss a proposed master bike and pedestrian plan after England citizens had their say with three public meetings and an online survey. Englanders were allowed to offer their opinions on priorities and make suggestions on the plan, which will connect everyday destinations for those who walk, bike and move in a safe, convenient way. Ultimately, this plan will encourage physical activity and economic development.

Isaac Sims (left) with Crafton Tull talks to Lenny Adams about the plan at a recent public meeting.

Isaac Sims, planner with Crafton Tull which created the master plan, said the survey results weren’t particularly surprising. Fifty-five percent of the respondents said they walked three or more times per week for either recreation or transportation. Around 92 percent said they did not ride a bicycle for recreation or transportation. Citizens at the July public meeting offered valuable input on sidewalks and, as a result, Crafton Tull added a sidewalk down Southwest First Street from West Fordyce Street to Cox Drive. The network of shared use trails, sidewalks and bike paths will equal approximately 17.25 miles.

Dave Roberts with Crafton Tull points out the potential for reworked sidewalks and a park to Leesa Freasier, physical activity coordinator with SPAN, on the walk audit in 2021.

The planning began last summer. The State Physical Activity and Nutrition for Arkansas (SPAN), part of the University of Arkansas for Medical Sciences (UAMS), funded the plan and helped organize a walk audit of downtown England to find trouble spots for pedestrians and bicyclists. A year later, the public weighed in on the initial drafts.

Mari Ben Newton, who moved to England in 2000 and attended the second public meeting in July, said she was most interested in a sidewalk on Nichols Street because she sees school kids walking that route every morning without the benefit of a sidewalk.

England’s Chief of Police Bill Duerson was keyed on safety too.

Bill Duerson and Mari Ben Newton decide how to vote on aspects of the proposed plan.

“I really like walking paths and safer routes, especially in the summer when kids are darting in and out of traffic,” said Duerson, who grew up in England riding his bike.

At the July meeting, Julie Kelso, vice president of planning with Crafton Tull, pointed to research that showed Lonoke County residents have a higher percentage of adult obesity than other counties in Arkansas, adding that Englanders could use opportunities to walk and bike to the grocery store, library, their work or school. And with 35 percent of England families having only one vehicle, families need safe options for non-motorized travel.

“What encourages bicycling or walking?” Kelso asked the group. “Safe, comfortable lanes with points of interest. If there are no facilities (for walking or biking), the stress level is high for biking or walking. As we move into safer facilities (safest being a separate trail), the stress is lower, but the ease of installing them is also less, meaning it takes more time and money to put them in place.”

Master bike and pedestrian plan for England

The firm used trip generators to expose “hot spots” of concentrated activity, such as the intersection of U.S. Highway 165 and Arkansas Highway 15. Another factor that Crafton Tull considered was the proposed United States Bike Route 80 (USBR80), which will meander through downtown England. The USBR80 snakes from North Little Rock to West Memphis as part of a larger route system across the United States for long-distance bicyclists. The proposed route will increase economic development in the towns dotted along the path, England being one of them. In addition to the USBR80, Metroplan (a planning agency for four central Arkansas counties) hopes to tie the England master bike and pedestrian plan to its own vision for the Regional Greenways project with more than 170 miles of multiuse paths connecting Faulkner, Lonoke, Pulaski and Saline counties.

Kelso said most of England’s proposed trails are concentrated in the southern part of the town with side paths along Nichols Street, a major corridor for children walking or biking to the high school.

Many of the existing traffic signals will have bike/pedestrian traffic signals added to them, and network trailheads will be centered around parks and schools in the city.

The blacktop will feature a walking path and sunshades. Sims said the block of blacktop in downtown England will have a widened walking path circling it and may be painted green with sunshades along it to protect pedestrians from the heat. Another need is to connect the sidewalk to the Willis H. Sargent Training Academy north of town and on Henderson Road.

Food Banks Going “Green”

Arkansas Food Banks Buying Healthier Foods with Help of Color-Coding System

The six Feeding America food banks in Arkansas are spending more of their money on healthier foods to stock their inventory, growing from 16 percent in 2018 to 47 percent in 2021 because of a simple color-coding system that categorizes foods as “choose often,” “choose sometimes” or “choose rarely” based on their nutritional value. Healthy food purchases at Arkansas food pantries is up

Jill Niemeier, former project manager with UAMS’ Office of Community Health and Research in Springdale, launched the color-coding intervention four years ago, which has spurred the upward trend in healthy food spending. She started at the top level with the State Food Purchasing Program where the six Arkansas food banks purchase much of their inventory. It’s a state-funded grant managed by the Arkansas Hunger Relief Alliance that allows the food banks to buy from Arkansas-based food distributors. Michelle Shope, director of food resourcing and logistics for Arkansas Hunger Relief Alliance who was an early partner with Niemeier, recognized the ease and benefit of using color-coding on their food order forms so food banks could quickly identify healthy options.

Color coding foods at the food bank level trickles down to their partner agencies (food pantries) and the individuals that depend on them for food. They’ll know which foods are healthier without having to interpret complicated nutrition labels. All foods are tagged with green (choose often), yellow (choose sometimes) or orange (choose rarely) depending on their saturated fat, sodium and added sugar. Even fruits and vegetables don’t get an automatic green label because some canned or frozen options have added sodium and sugar. The coding is based on the Healthy Eating Research Nutrition Guidelines for the Charitable Food System, also known as HER.

Jill Niemeier, former project manager with UAMS’ Community Health and Research in Springdale, checks an inventory list with Value Added Food Sales operations manager, Derek Mounce.

The project grew wings when Michigan-based food distributor Value-Added Food Sales entered the state in 2021. Value-Added distributes food to non-profit and other charitable food organizations across the nation. Its new warehouse in Springdale, Arkansas, allowed food banks to buy from it through the State Food Purchase Program. The food distributor has been working with the UAMS team to sort, rank and color-code its inventory, based on nutrition information for its 200-plus food items. Niemeier said the color-coded labeling could expand beyond Arkansas, benefitting any organization that purchases from Value-Added Food Sales. The company distributes to 50 states as well as Puerto Rico.

“This partnership is very exciting,” Niemeier said. “Color coding or otherwise labeling food items is a simple intervention that has the potential for great impact. Taking the burden off of food banks and other purchasing agencies to decipher nutrition labels makes it easier for them to make informed choices about the foods they are purchasing.”

Niemeier had worked alongside the UAMS Department of Family and Preventive Medicine’s State Physical Activity and Nutrition for Arkansas (SPAN) which seeks to lower obesity in Arkansas by promoting healthy eating, physical activity and breastfeeding. The program is funded by the Centers for Disease Control and Prevention with the goal to reduce obesity and the chronic illnesses that come with it, namely diabetes.

It’s especially important that those who are food insecure have healthy options since diabetes is more prevalent in this group. Ten percent of Americans have diabetes and a third have prediabetes, but for those who are food insecure, diabetes is twice as common, according to healthaffairs.org. Food insecurity can worsen diabetes in many ways including less access to nutritious foods, higher distress related to diabetes management, and difficult trade-offs such as choosing between food and medications.

“I believe these kinds of nutrition interventions are meaningful because diet-related diseases are more common among individuals who are food insecure, and it requires both a top-down and bottom-up approach to help mitigate that,” Niemeier said. “I hope projects like these will continue across the charitable food system so individuals will have access to healthy foods for themselves and their families.”