Medicine and Health Sciences Commons^™

Cost Of Eating Well, Jake Ermolovich

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

No abstract provided.

Over-The-Counter Approval Of Progestin-Only Pills, Hannah Grace Donovan

Family Medicine Clerkship Student Projects

Most women in the United States use contraception at some point in their life. While there are many types of short- and long-acting reversible birth control options available via prescription, the oral contraceptive pill (OCP) remains the most used reversible contraceptive agent. The proportion of those using an OCP is inversely proportional with age; more specifically, people who can get pregnant between the ages of 15 and 29 use OCPs most frequently. However, people in this age range may face increased barriers to obtaining contraception, such as cost, insurance, social and familial factors, policy, transportation, and access to healthcare. In …

Increasing Patient Education On Proper Antibiotic Stewardship, Arif S. Ahsan

Family Medicine Clerkship Student Projects

Antibiotic resistance is a growing public health issue in the United States. Coinciding with this, patients often inappropriately self-treat infections using antibiotics. Locally, this causes complications in treating patients in an outpatient setting, and nationally, this causes an increased economic burden on the United States healthcare system. A handout was developed for distribution at pharmacies in order to better educate patients on proper antibiotic stewardship, based on information that providers believed to be most important for patients to know.

Screening For Areca (Betel) Nut & Quid Use, Gabriela Sarriera Valentin Ms

Family Medicine Clerkship Student Projects

Standardized screening tools for patients who use betel quit and areca nut products do not currently exist. Given the increased risk of oral and oropharynx cancer development in this patient population, increasing awareness of this practice could result in decreased morbidity and mortality. The purpose of this project is to (1) increase provider awareness of this cultural practice and its associated health consequences, (2) to develop a screening tool, and (3) to propose suggested follow-up when concerning lesions are identified.

Improving Knowledge Of Contraceptive Options In Teenage Male Populations, Anthony Quach

Family Medicine Clerkship Student Projects

Despite a plethora of contraception available on the market, nearly 50% of pregnancies in Vermont are unintended. Currently, most educational initiatives aimed at improving contraceptive usage are targeted towards individuals with uteruses, and not their partners with penises. Both qualitative and quantitative data suggest that there are significant gaps in this latter population’s knowledge about contraception for various reasons like limited contraceptive education within formal sexual education in schools, lack of parental and/or physician discussions about contraception, and various complex social and cultural factors. This intervention aims to bridge the knowledge gap in this population by using an educational pamphlet. …

The Role Of Food Insecurity With Hunger And Physical Activity Level On Binge Drinking Among Vermont High School Students, Joe Stacy, Codi Williams, Zyakkiriah Rhoden, Han Naung Tun

Master of Public Health Culminating Projects

Objective: To determine the association of hunger, physical activity, Black Indigenous People Of Color (BIPOC) status , and BMI percentile on binge drinking among Vermont high schoolers.

Methods: A cross-sectional study was conducted on Vermont high school students aged between 12 to 18 years (n=18,540) using data obtained from the 2019 Youth Risk Behavior Survey of the Vermont Department of Health. Multiple logistic regression models were utilized to investigate the correlation between binge drinking status and hunger status, physically active status, BIPOC status, and Body Mass Index percentile.

Results: Binge drinkers had significantly higher levels of hunger …

Evaluating The Indirect Effects Of A Community-Based Child Obesity Prevention Program On Adult Health Behaviors, Emily K. Rocheleau

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Community-based intervention (CBI) programs aim to change individuals’ behaviors to reduce the risk of chronic disease, often by addressing factors that contribute to obesity. To provide information for improving interventions, program evaluation is needed. In Franklin and Grand Isle Counties, childhood extreme obesity decreased where a child-targeted, obesity prevention focused CBI was implemented. It has been shown that these programs can have an indirect effect on parent health/body mass index (BMI), but it is unclear if indirect effects of such programs have an impact on adult BMI and related health behaviors. The purpose of this project was to determine …

Change In Food Security And Health Outcomes Since The Covid-19 Pandemic In Northern New England, Jennifer Laurent, Farryl Bertmann, Mattie Alpaugh, Emily H. Belarmino, Sam Bliss, Jonathan Malacarne, Ashley C. Mccarthy, Scott C. Merrill, Rachel E. Schattman, Kathryn Yerxa, Meredith T. Niles

College of Nursing and Health Sciences Faculty Publications

We conducted a Northern New England survey in March-June of 2021 to understand the initial and continued impacts of the COVID-19 pandemic on food security, health behaviors, and health outcomes. A total of 988 adults (562 in Maine and 426 in Vermont) responded regarding food access and availability, health behaviors such as diet composition and exercise, and use of habit-forming substances (e.g. alcohol, tobacco, etc.) before and in the year following the onset of the COVID-19 pandemic. Key findings include: 1. 39.1% of Maine and 43.2% of Vermont respondents indicated weight gain since the start of the COVID-19 pandemic. 2. …

Return To Play Following Covid-19, Tyler Landman

Family Medicine Clerkship Student Projects

Covid-19 infections among adolescents have led to significant decreases in physical activity and fitness. Many adolescents have been subject to return to play clearance before being able to get back to their sport. Protocols are not only a moving target but are also different from school to school, and county to county. Many patients are not involved in the decision making process of when they get to play again, and furthermore end up being out of sport longer than they need to due to the ordering of unnecessary tests, and long wait times for them. The aim of this study …

Peri-Operative Optimization: Social Determinants Of Health, Adam F. Kohutnicki

Family Medicine Clerkship Student Projects

This project investigated how clinicians at a rural Vermont family medicine practice observed various social determinants of health (SDOH) of their patient population affected patients' preparedness for surgery. Two clinicians involved in the community, a practicing family medicine physician and a practicing social worker, were interviewed to collect qualitative data on how various SDOH they have observed through their clinical practice have influenced patients' preparedness for surgery. This information was then utilized to create a "dot-phrase" that clinicians can use as part of a patient's pre-operative visit in the outpatient setting to assess SDOH and plan subsequent targeted interventions to …

Improving Access To Medication Assisted Treatment For Opioid Use Disorder In A Rural Emergency Department, Warren Grunvald

Family Medicine Clerkship Student Projects

Opioid Use Disorder (OUD) is a growing epidemic throughout the United States and Maine has not been sparred by this. As the Emergency Department is a frequent location for people with OUD to interact with physicians it has been targeted as an opportunity to initiate Medication-Assisted Treatment (MAT) with Suboxone. This project details an effort to streamline this process and improve outcomes for patients interested in MAT.

Improving Identification Of Dermatological Conditions In Skin Of Color, Sam Afshari B.S., Simran Kalsi M.S.

Family Medicine Clerkship Student Projects

Vermont primary care practitioners are less likely to have experience diagnosing dark skin tones given that the state population is 94.2% white. Only 4.5% of images in general medicine textbooks and 4-19% of images in dermatology textbooks depicted darker skin. Black patients are significantly less likely to see a dermatologist, which highlights the importance of diagnosis at the primary care office.

Approach To Providing Culturally Sensitive Gynecologic And Obstetric Care For Somali Women, Izabella Ostrowski

Family Medicine Clerkship Student Projects

Many refugees have fled Somalia over the past 30 years due to political instability and civil war. Since 1980, over 8,000 refugees have settled in Vermont, with about 9% of refugees being from Somalia. Community Health Centers of Burlington (CHCB) provides prenatal and primary care to many Somali women in the community. There are known gynecologic and obstetric health disparities for Somali women, such as significantly lower completion rates of mammography and pap smears than non-Somali patients. Research has shown that an understanding of cultural health beliefs and values are crucial for creating tailored prevention programs for refugee women. This …

Improving Access To Mental Healthcare For Primary Care Patients, Kaela Mohardt

Family Medicine Clerkship Student Projects

Access to mental health resources both nationally and in Vermont has become a challenge for both primary care clinics and patients to navigate. Attributed to a multitude of factors including cost barriers, limited health professional availability, societal stigma, this is a behavioral health need that requires attention to improve success of patients receiving mental healthcare. This project focuses on addressing one aspect of that need from a clinical level, creating and updating a referral handout for both patient and provider use. The outcome of this project aims to increase the likelihood of successful patient referral to needed mental health resources.

Food Security And Assistance Programs In Vermont Before And During Covid-19, Madeleine Burke, Ashley C. Mccarthy, Emily H. Belarmino, Farryl Bertmann, Meredith T. Niles

College of Agriculture and Life Sciences Faculty Publications

Here we surveyed a cohort of Vermonters at three time points over the first year of the pandemic. The surveys were conducted in March/ April 2020, June 2020, and March/April 2021. The demographics of the 441 Vermonters who responded to all three surveys are comparable to average Vermont demographics on income, but the respondents were more likely to have a college degree and to identify as female. This brief explores how the use of food assistance programs varied within this population and changed over the course of the pandemic. Key findings include: 1. The number of Vermonters using food assistance …

More Than A Meal : A Resource For Communities Striving For Food Sovereignty Through The Charitable Food System, Kaitlin J. Robertson

Food Systems Master's Project Reports

The 2020 pandemic and economic crisis showcased the fragility of the American food system. In the months of quarantine and lockdowns, a growing number of Americans searched for ways to feed themselves and their families. Community-based and volunteer-supported feeding programs worked to bridge the divide between the hungry and their next meal. In many cases, these programs rely on an unpaid workforce and donations – of time, food, and facilities. With limited resources, volunteer-led programs often lack centralized training options; this guidebook seeks to fill that void. This project is a streamlined, introductory-level guide for volunteers and community members working …

Marijuana Vaping In Adolescents: Evaluating Provider Knowledge And Practices To Improve Screening And Referral To Treatment, Holly T. Whitcomb

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Vaping is a public health epidemic. Adolescents are using cannabis electronic vapor products at increasing rates. In teens, rising E-cigarette and vaping product use associated lung injury (EVALI), tetrahydrocannabinol (THC) intoxication and addiction are concerning. Primary care providers are in a unique position to screen and discourage adolescents from vaping, yet barriers to screening and referral to treatment exist.

Objective: This project provided education on vaping trends, Screening, Brief Intervention, and Referral to Treatment (SBIRT), and Screening to Brief Intervention (S2BI) with the goal of improving screening and brief intervention of at-risk adolescents among primary care providers.

Methods: The …

Evaluation Of The Cost-Effectiveness Of A Community Obesity Prevention Program, Tristan Devine, Dnp, Jennifer Laurent, Ph.D, Aprn

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Community-based obesity programs have become a common intervention to address childhood obesity. A majority of these programs have not estimated the cost-effectiveness of their interventions.

Purpose: Determine the fiscal impact of a community obesity prevention program in the state of VT.

Methods: Community Programs and Policies Intensity (CPPI) scores were calculated for Franklin and Grand Isle (FGI) from 2017-2019. Changes in childhood obesity from 2017-2019 were analyzed and subsequent health care cost savings were calculated based on observed obesity changes. Change in CPPI scores were compared to expected change in obesity to allow forecasting for biannual health care cost …

Food Insecurity In Vermont Households: An Analysis Of The Association With Tobacco Use, Alcohol Consumption And Physical Inactivity, Hannah R. Kaufman, Kyleigh Savoie, Emily Belanger, Kijonna Bowman, Darren Childs, Hendrika Maltby

Master of Public Health Culminating Projects

Objectives: To assess the relationship between chronic disease risk behaviors: tobacco usage, alcohol consumption, sedentary lifestyle, and food insecurity (FI) among Vermonters. Methods: This cross-sectional study uses a sample (n= 1,378) from Vermont’s 2018 Behavioral Risk Factor Surveillance System (BRFSS). The examined outcome is FI. The predictor measures were defined as at-risk tobacco use, alcohol consumption, and sedentary lifestyles.The following were established as covariates on the association between the dependent and independent variables: income, sex, age, race/ethnicity, and activity limitations. Results: In the unadjusted binomial logistic regression (Table 2), tobacco users were 3.32 times more likely to be food …

Age Well: Home Health Care Shortages In Northwestern Vt During The Covid-19 Pandemic, Jeremy Altman, Matthew Breseman, Edom Alemayehu Girma, Alexander M. Kubacki, Louisa Moore, Amanda Nattress, Noah Sorkow, Kristen Wright

Public Health Projects, 2008-present

As of February 2021, there have been over 26.6 million cases and over 450,000 deaths in the United States due to COVID-19. Since the outbreak, a critical focus in the healthcare system has shifted towards protection of healthcare providers as well as vulnerable patients such as the elderly. The growing shortages of providers has resulted in a growing need for home health care (HHC). Beyond HHC addressing this workforce gap, evidence has shown a reduction in emergency department (ED) visits, hospital admissions and a 14- million-dollar savings in healthcare cost. While the role of HHC has been crucial for the …

Assessment Of Snap Utilization And Accessibility In Vermont, Amanda Galenkamp, Mohamad K. Hamze, Elie Kaadi, Elise A. Prehoda, W. Evan Shaw, Nicole A. Walch, Shari J. Zaslow, Paula Tracy

Public Health Projects, 2008-present

Food insecurity exemplifies one of the many public health crises that the COVID19 pandemic both exposed and amplified. In 2019 an estimated 10.5% of households (13.7 million households) were food insecure as determined by the US Department of Agriculture (USDA) including 5.3 million children. In 2020 this number increased to 15.6% of households, including 17.0 million children as projected by Feeding America. Food insecurity in children, especially in infancy, is associated with the development of obesity and hyperlipidemia, highlighting the necessity of federal and state food assistance programs.

We believe that increased funding for SNAP incentive programs and wireless EBT …

Perceptions Of Mask Use During The Covid-19 Pandemic, David Bachoy, Clara Berard, Nicholas D. Brunette, Sadie M. Casale, Tonya Conley, Krystal Gopaul, Tyler Landman, Rhys Niedecker

Public Health Projects, 2008-present

The CDC recommends covering of the face and nose during the COVID-19 pandemic as a primary mitigation strategy for viral transmission. Masks minimize the number of viral particles emitted by the wearer; mask use serves to reduce the effects on population transmission.

Mask wearing behaviors have been shown to vary across different groups like gender identity, however, differences between people with and without lung disease have yet to be explored.

Goal: Examine perceptions, attitudes, and behaviors related to mask use during the COVID-19 pandemic of those with and without lung disease nationally.

Motivators For Convalescent Plasma Donors During The Covid-19 Pandemic, Betsy Assoumou, Natalie J. Bales, Amy K. Chang, Hannah K. Cook, Kiana Heredia, Colby J. Fischer

Public Health Projects, 2008-present

This study will seek to explore the motivators for convalescent plasma donors during the COVID-19 pandemic.

In 2020, the global pandemic caused by SARS-CoV-2 increased donations of transfusion products, particularly convalescent plasma from COVID-19 survivors that is used to provide passive antibody immunity to those infected. Convalescent plasma therapy has been identified as one of the only therapies for COVID-19 beyond supportive care.

Much of the current research focuses on the current motivators of whole blood and plasma donations, commonly citing altruistic motivations, knowing someone who has previously donated, and social media influence as common motivators for donations.

It is …

Health Benefits Are Associated With Employment Status For People With Intellectual Disabilities, Rachel Bombardier, Mialovena C. Exume, Jeremy Frank, Timothy W. Greenfield, Kaela Mohardt, Nathan Schweitzer, Devan Spence

Public Health Projects, 2008-present

Recent studies demonstrate that people with developmental disabilities are at increased risk for preventable illnesses. In our study, we examined several variables suspected to be major contributing factors, with emphasis on job security and employment. The development of sheltered workshops was initially an attempt to promote employment opportunities for people with intellectual and developmental disabilities (IDD), though at subminimum wages.

We explored whether these workshops allow for adequate community and healthcare engagement that is necessary for overall health and wellbeing. We designed a study that allowed us to statistically compare health-related data among states that eliminated sheltered workshops with those …

Assessing Cancer Prevention Knowledge During Covid-19 Pandemic, Robert Anthony Adamian, Lily Deng, Nicholas W. Krant, Trevor Ar Mcdonald, Natalie Qin, Ally Sarkis, Althea Jem Darbin Tapales

Public Health Projects, 2008-present

In response to the COVID-19 pandemic, adjustments in the provision of health care resources have caused a significant decrease in cancer screenings. These missed screenings may have considerable impacts on patients, health care practitioners and health systems.

In addition to the importance of resuming timely screening, studies have shown that a large portion of cancer deaths stemming from breast, skin, and colorectal cancer are preventable by risk factor modification at the patient level.

Many people remain uncertain of how best to prevent cancers, despite general awareness of concerns.

Raising awareness can empower patients to reduce their risk factors for developing …

No Fall Too Small: Assessing Barriers To Fall Prevention Programs, Christina Cobb, Arley Donovan, Heather G. Giguere, Arjune Singh Nibber, Brian L. Shaw Ii, Aathman Swaminathan, Ryan Warner

Public Health Projects, 2008-present

In Vermont, 1/3 of adults 45 years or older fell in the year 2018, statistically above the national average, which has not changed since 2012. Of those who fell, 34% experienced an injury after their fall.

Evidence-based interventions and fall prevention programs effectively reduce falls, and these programs aimed at reducing falls appear to reduce fractures. In fact, it has been shown that exercise intervention reduces fall risk by 30%.

Our review of the literature highlighted that there are numerous barriers to accessing fall prevention programs, including loss of independence, transportation, cost, and lack of interest. With this in mind, …

Initial Assessment Of A Suicide Prevention Resource For Vermont Primary Care, Sam Afshari, Eliot Binkerd-Dale, Zain Chaudry, Varun Gupta, Morgan Howlett, Colleen Mccarthy, Benjamin N. Price, Rebecca B. Rawlings

Public Health Projects, 2008-present

Suicide is the second leading cause of death for Vermonters ages 10-44. Studies have shown that of those who die from suicide 45% have seen their primary care provider in the month prior to their death and only 20% saw a mental health provider.

To help strengthen suicide risk screening in primary care, a group of Larner College of Medicine students partnered with Chittenden Accountable Community for Health to curate a suicide prevention informational resource to be used in Vermont's primary care practices to promote universal suicide screening.

We then surveyed users of the tool to assess its utility and …

Vermont School Districts Meal Service Response To Covid-19, Stephen Brand, Will D. Buick, John E. Fernan, Gina Jin, Rebecca Lapides, Jennifer Lor, Paul Mccleary, Timothy L. Long

Public Health Projects, 2008-present

The COVID-19 pandemic has posed many challenges worldwide, including lack of food access and security. Food insecurity in Vermont has increased from 18% to 24% since the outbreak of the pandemic.

Food insecurity among families with school-aged children puts children at risk for developmental delays, poor social functioning, and poor academic performance.

The goal of this project is to identify the challenges that the COVID-19 pandemic has posed for meal distribution services in school districts across Vermont, recognize the adaptations that were made by schools to address these challenges, and determine which adaptations had positive effects to encourage widespread implementation …

Bridging The Gap: Improving The Relationship Between Social Service Organizations And Healthcare Providers, Gabriela Bosmenier Cruz, Linda L. Cui, Liberty J. Dupuis, Ian Guertin, S. Halsey, Ying K. Loo, Finlay Pilcher, Joaquin Reategui

Public Health Projects, 2008-present

In Vermont, a significant social determinant of health is rurality. Barriers to healthcare services include distance to providers, lack of integration with social services, and failure to recognize community needs.

Integration and robust collaboration between healthcare and social services can likely improve outcomes for individuals who have high utilization of both categories of services.

Understanding relationships between healthcare and social services may provide an important framework for translating interventional research to rural communities to improve health equity.

Project Goal: To understand barriers affecting collaboration between social service providers and community health providers in order to promote research-based improvements in health …

Addressing The Needs Of Sara Holbrook Community Center Caregivers, Stephen J. Foley, Shubhankar Joshi, Ankrish Milne, Izabella Ostrowski, William Robinson, John A. Steinharter Ms, Rachel A. Wayne, Alayna M. Westcom

Public Health Projects, 2008-present

Previous research: parental stress can negatively impact behavioral and cognitive development of children.

Each year, over 4,000 people use SHCC resources: preschool, after school care, teen programs, food shelf, ESL services, etc.

SHCC supports families at the center itself, but many families still experience difficulties at home that contribute to caregiver stress.

The purpose of this study: understand the needs of the caregivers of students who attend SHCC and propose actionable solutions to address the top identified needs.