Public Health Commons^™

Opportunities And Barriers To Implementing Tobacco 21 In Vermont, Audrea Bose, Cameron Burke, Jack Chen, Jenna Dafgek, Kathryn Kurchena, Alexander Miller, Catherine Pratt, Rebecca Ryan, David Kaminsky

Public Health Projects, 2008-present

Introduction

• Tobacco is the leading cause of preventable disease and death in the U.S. Demographics

• Approximately 90% of current smokers starting smoking before age 182

• Earlier age of tobacco use initiation associated with lower rates of smoking cessation

• The proposed Tobacco 21 bill (T21) would raise the minimum legal age of sales to 21, creating the opportunity to reduce tobacco use initiation

• Within five years of implementing the nation’s first T21 bill in 2005, the 30-day smoking rate in Needham, MA dropped from 13% to 7%

• Recently in Vermont, the age of gun sales …

Training: Key In Recognizing Potential Trafficking Victims In A Healthcare Setting, Alexis Dela Cruz, Jennifer Holland, Ibrahim Hussein, Dylan Koundakjian, David Viscido, Candice Wolf, Hannah Woodruff, Edith Kilmoski, Mariah Mcnamara

Public Health Projects, 2008-present

Background

• Human Trafficking (HT) is a crime that involves exploiting a person for labor, services, or commercial sex.

• HT can happen in any industry, to persons of any gender, age, economic status, religion, and nationality.

• In FY 2018, service agencies in the State of Vermont submitted over 180 reports of HT.

• HT has a profound negative impact on survivors’ physical and mental health.

• 25-88% of HT victims interact with a healthcare professional while they are being exploited.

• Providers have cited a lack of confidence and knowledge on HT as a major barrier to proper …

Impact Of Interactions Between First Responders And Opioid Drug Users, Rio Beardsley, Pirapon Chaidarun, Kalle Fjeld, Benjamin Grebber, Brian Muchmore, Ellen Seyller, Lauren Struck, Heng Tan, Peter Jacobsen, Jerry Larrabee

Public Health Projects, 2008-present

INTRODUCTION

In 2017, First Responders (EMS, Police, and Fire Department) in Vermont administered 848 doses of naloxone (Narcan®), an opioid antagonist that can block the effects of opioids in overdose. However, the rate of opioid-related fatalities has continued to rise from 74 in 2015 to 101 in 2017. Vermont CARES, a nonprofit organization, helps address this issue by working “for and with Vermonters affected by HIV/AIDS to promote well-being through a continuum of prevention, support, and advocacy services.” Their syringe service programs throughout the state provide access to clean needles, overdose prevention education, and naloxone.

AIMS

1. To better understand …

Assessing Food Insecurity Screening Among Healthcare Providers In Vermont, Menna Awadalla, Juan Conde Fabela, Annabelle Davey, Jack Dubuque, Jhaimy Fernandez, Ian Mcclain, Haewon Park, Connor Scagnelli, John Gorton, Shaden Eldakar-Hein

Public Health Projects, 2008-present

What influences primary care providers’ screening for food insecurity and recommending food resources?

This study examined the barriers primary care providers have to screening for food insecurity and recommending resources to their patients. By analyzing the factors that drive or prevent providers from making recommendations, we can help address food insecurity within the healthcare setting

• Food security is defined as having access to enough food in order to maintain an active and healthy life

• An estimated 1 in 8 Americans suffer from food insecurity, which is associated with adverse health outcomes and an increase of $77.5 billion in …

Converting Whole Blood Donors To Apheresis Donors, Collin Anderson, Racquel Decastro, Alexa Golden, Sidney Hilker, Flora Liu, Vincent Nocera, Seth Wolf, Jenny Lamping, Mark Fung

Public Health Projects, 2008-present

Donating blood is a noble act with real potential to save lives. Although millions of Americans donate blood each year, supplies of one blood component—platelets—is in chronically short supply. This is in part due to its significantly shorter shelf life (5-7d) vs. red blood cells (28-42d) or plasma cells (1yr). Platelet apheresis donation offers the opportunity to donate platelets more frequently and in higher quantities but accounts for only a small percentage of all donations. Our study aimed to better characterize perceived barriers in conversion to platelet apheresis donation.

Attitudes & Behaviors Surrounding Active Commuting In Chittenden County, Vt, Daniel Bak, Elizabeth Congdon, Doré Grier, Naira Goukasian, Max Silverstein, Georges Tahhan, Katrina Thornburgh, Rebecca Jones, Chester Areson, Dan Quinlan, Meredith Graves

Public Health Projects, 2008-present

Climate Change, Active Commuting, and Health

• Climate change contributes to 7 million deaths/year globally

• Negative health outcomes from increased carbon emissions include heat-related illness, mental health issues, and respiratory and allergic disease

• Active commuting reduces carbon emissions, promotes physical activity, and reduces chronic diseases such as hypertension, diabetes, and obesity

Active Commuting in Chittenden County

• Only 8.5% of Vermonters commute actively

• Burlington has been intensely promoting active commuting through developments in infrastructure and safety

• Most Burlington residents still commute by car

Project Goal

• Compare how active commuters and non-active commuters in Chittenden County …

Safe Driving Attitudes And Behaviors Among Vermont Student Drivers, Samantha Bissonette, Megan Garrido, Nicholas Haslett, Ashton Pike, William Prince, Davina Tolbert, Catherine Westbom, James Lockridge, Wendy Davis

Public Health Projects, 2008-present

Distracted driving contributes to approximately 10% of all driver fatalities and 17% of injuries in the US. Vehicle crashes are the leading cause of death for teens in the US. Drivers aged 16-19 are 3 times more likely to be involved in fatal crashes than those > 20 years. Increased teen risk is related to attachment to technology, limited driving experience, and an illusion of invincibility. Previous National Highway Traffic Safety Administration assessment of distracted driving attitudes and behaviors does not include significant data on teenage drivers. The goal of this project is to assess safe driving attitudes and behaviors among …

The Effect Of Food Insecurity Training On Knowledge, Awareness, Screening, And Intervention Practices Within Two Pediatric Wards At An Academic Medical Center, Jonathan Borden, Hillary Danis, Christina Dawson, Max Knapp, Jessica Lyon, Jordan Munger, Nam Trinh, Katy Davis, Alison Howe

Public Health Projects, 2008-present

Background and Introduction

• Food insecurity is a major driver of preventable disease. Providers can screen to identify patients at risk for food insecurity using a two-question survey tool called “The Hunger Vital Sign”. Screening barriers identified in the literature include lack of provider knowledge, comfort, and capacity for effective intervention. Addressing this provider knowledge gap through training is essential for implementing robust and sustainable clinical food insecurity screening practices.

• This study aims to evaluate the effect of food insecurity education on providers’ knowledge and awareness of food insecurity and their likelihood to screen and make referrals for at-risk …

Effects Of Nostalgia Directed Music Therapy On Residents With Dementia In Nursing Home, Garrett Chan, Jack Fitzsimons, Sidika Kajtezovic, Kristen Keene, Marc Kostrubiak, Jessica Sikka, John Vandenberge, Shaden Eldakar-Hein, Cameron Segal

Public Health Projects, 2008-present

Background

• Studies support a beneficial relationship between music therapy and the management of dementia.

• Music therapy intended to activate memory may improve apathy and decrease cognitive decline in patients with mild to moderate dementia.

• Individuals are typically most influenced by music encountered during early adulthood.

Objective

To analyze the effect of nostalgia directed music therapy on the quality of life of nursing home residents with moderate to severe dementia.

The Halo Effect: Does In-Hospital Art Intervention Result In Improved Overall Patient Satisfaction?, Brian Gross, Olivia Harrison, Olivia Larkin, Collin Love, Sean Meagher, Alice Peng, Stephanie Udawatta, Karen Lounsbury, Rebecca Schwarz

Public Health Projects, 2008-present

Introduction

The positive impact of art therapy on medical patients has been well established in the literature.

• Association between visual art creation and maintenance / reconstruction of a positive identify throughout cancer treatment

• Decreased need for narcotic medications and patient length of stay following participation in guided imagery sessions

Despite an abundance of research on art therapy, few studies have examined impact of in-hospital art intervention on overall patient satisfaction.

Objectives

• Examine impact of Art from the Heart (AFTH), an in-hospital art intervention program, on patient interpretation of overall care received during hospital stay—the ‘halo effect’. …

Vermont Legislators' Opinions Regarding The Opioid Epidemic, Liam Du Preez, Emily Eichner, Jonathan Gau, Ryan Harned, Matthew Lebow, Bridget Moore, Casandra Nowicki, Elizabeth Cote, Charles Maclean, Jan Carney

Public Health Projects, 2008-present

Introduction

• The VT General Assembly includes 180 legislators: 150 representatives and 30 senators

• State legislators have substantial power to create opioid-related policies

• During the 2017-18 VT legislative session 22 opioid related bills were introduced and 9 were passed

• No data currently exist on how VT legislators gather information and formulate public health decisions regarding opioid policies

Purpose

• Examine VT legislators’ understanding of the opioid epidemic

• Identify what drives legislators to draft legislation, including beliefs, priorities, and voting decisions

• Inform health and human services professionals to best respond to legislators’ knowledge gaps and continuing …

Community Awareness And Utilization Of School Based Health Centers In Burlington, Vermont, Sarah French, Cinduja Nathan, Kenneth Palanza, Sienna Searles, Sarah Sherman, Joshua Taylor, Michael Weber, Rebecca Mccray, Matthew Saia, Barbara Frankowski

Public Health Projects, 2008-present

Most K-12 students will miss at least one day of school each year due to illness or injury; in 2010, six percent missed 11 days or more. School Based Health Clinics, SBHC, are provider-based health clinics located in schools, supplementing routine nursing care and complementing the role of a pediatrician while the child is in school.

SBHCs aim to:

• Reduce the amount of school that students miss

• Provide quick and convenient care for a variety of routine and acute medical concerns

Our objective was to:

• Investigate community awareness and utilization of the SBHCs in the Burlington School …

Oral Health And Barriers To Care In Burlington Housing Authority Residents, Cari Carpenter, Andrew Darling, Reed Hausser, Mary Ann Kelly, Adam Lacayo, Elizabeth Lanata, Scott Olehnik, Molly Moore, Taylor Puckhaber

Public Health Projects, 2008-present

Background

Oral health affects everyone and serves as a model for the long term benefits of establishing preventative health practices early in life. However, children with significant socioeconomic stress or cultural and language barriers to access may have difficulty obtaining oral hygiene information, or developing and maintaining oral health regimens. The Burlington Housing Authority (BHA) provides housing subsidization to low-income families and services many resettled refugee families in Burlington, VT. We recognize some intervention initiatives are already and place, and will evaluate program efficacy and utilization. Ultimately, we seek to understand barriers to the existing programs and recommend strategies to …

Evaluation Of Interactive Rhythm Activities On The Engagement Level Of Individuals With Memory Impairments, Jared Bomba, Raghav Goyal, Marc Hammond, Van Hoang, Alexander Karabachev, Laura Nelson, Hanaa Shihadeh, Judith Christensen, Ellen Meagher

Public Health Projects, 2008-present

Alzheimer's dementia can lead to a decreased quality of life in patients through the manifestation of inappropriate behavioral and psychological signs and symptoms. Music therapy has been shown to decrease agitation and disruptive behaviors in patients with dementia, although improvement in overall cognitive function was minimal. However, there is evidence showing an increase in grey matter in those who actively participate in music activities. Our goal in this study is to focus on how participation in rhythm-based activities affects quality of life.

Understanding And Evaluating Quality Of Life For Individuals With Intellectual Disabilities: A Northwestern Vermont Population Study, Karla Brandao-Viruet, Katherine Callahan, Michael Chmielewski, Samuel Epstein, Elizabeth Lynch, Emily Puleo, Derek Tan, Mike Reilly, Stephen Everse

Public Health Projects, 2008-present

Introduction

There are 7-8 million individuals with intellectual or developmental disabilities living in the US.

• 91,795 of this population lives in Vermont

• Historically marginalized and isolated community

• Socioeconomic, health-related, and emotional burden

• Public health-related disparity

Champlain Community Services (CCS): non-profit service provider and coordinator for 86 persons with intellectual disabilities in Northwestern Vermont

Objectives:

• Develop and apply measures to better understand and evaluate quality of life in the population CCS serves.

• Recommend improvement to CCS data collection and evaluation methods.

• Provide a basis for future recommendations to CCS services that are aligned to …

Legislator Beliefs, Perceptions, And Voting Influences Regarding Carbon Pricing: Implications For Climate Change And Health Advocacy, Joy Benner, Istvan Kanyo, Meri Lackie, Evan Lowry, Shivani Seth, Alan Su, Jill Jemison, Raj Chawla, Sally Kerschner

Public Health Projects, 2008-present

Carbon pricing was proposed to reduce carbon emissions which has been linked with negative health effects such as:

• Increased incidence of heat stroke

• Food poisoning

• Malnutrition via food shortages

• Vector-borne illnesses

• Asthma

• Allergies

Purpose: To understand factors that affect legislators’ carbon pricing voting, guiding future health educators and advocates.

Needs Assessment Of Winooski Food Shelf Clients, Susan Campbell, Lexi Churchill, Michael Lawrence, Shae Rowlandson, Kathryn Thomas, Matt Tsai, Timothy Woodin, Linda Howe, Jan Carney

Public Health Projects, 2008-present

Food shelves offer a unique, centralized location to engage with populations with multiple needs. Food shelf clients demonstrate poorer overall health and less access to healthcare and other social services. Winooski has a large refugee and immigrant population, whose needs may differ greatly from clients served by nearby food shelves in Chittenden County. Winooski Food Shelf visits provide opportunities to link clients to other needed health and social services. Previous studies have demonstrated efficacy in resource intervention guided by information gathered from food shelf clients.

PROJECT GOAL: Assess the greatest health and social needs for clientele of the Winooski Food …

Adolescent Alcohol Usage In Vermont State: A Review Of Underage Drinking And Its Associations With Suicidality, Cecilia Idman-Rait, Karly Fischer, Shirley Callaghan, Rachel Danis, Caitlin Rettenmaier, Michelle Shepard

Master of Public Health Culminating Projects

Objective To understand adolescent alcohol usage in Vermont and its associations with suicidality.

Methods A cross-sectional study, utilizing 2017 high school VT YRBS data. Multiple logistic regression and chi-square tests were run using SPSS 25 software. Two groups of survey respondents were selected to represent alcohol usage, Binge Drinkers and Non-Binge Drinkers. Suicidality was analyzed by group, controlling for the predictor variables: age of first drink, grade level, gender, mental health/depression diagnosis, other drug usage, socioeconomic status, and ease of access to alcohol.

Results This study provides state-specific data regarding increased likelihoods of suicide and underage drinking in Vermont. Conclusions …

Associations Among Healthcare Utilization And Binge Drinking, Ethan Grey, Chad Phalon, Anna Greene, Patricia Harmeyer, Kalyn Rosenberg, Cristine Griffing, Tom Delaney

Master of Public Health Culminating Projects

Objective. To examine associations among routine healthcare services and binge drinking in Vermont adults.

Methods. We analyzed a cross-sectional sample of randomly selected 6516 adults who participated in the self-reported 2017 Vermont Behavioral Risk Surveillance System survey. We estimated odds ratios for responses indicative of binge drinking in association with length of time since last routine checkup using a bivariate logistic regression model.

Results. Participants who reported binge drinking were 31% (OR = 0.69, 95% confidence interval [CI] = 0.56, 0.83) less likely to engage in a healthcare visit within the past year controlling for age, employment status, annual household …

Electronic Vapor Product Use And Suicidal Behavior In Adolescents, Vy Bao Cao, Allison C. Greene, Courtney Williams, Chelsey Little, Julia Kaya, Beth Awhaitey, Kelsey Gleason Donovan

Master of Public Health Culminating Projects

Objective: To determine whether an association exists between electronic vapor product use (EVP) and suicidal behavior in middle and high school students

Methods: Multilevel logistic regression analysis for suicidal behaviors using data from the 2017 Vermont Youth Risk Behavior Survey.

Results: Middle school EVP users were significantly more likely to report suicidal behavior than non-users. No statistically significant association was found in high school students.

Discussion: While further study is necessary to clarify the relationship between EVP use and suicidal behavior, these findings highlight the need for suicide prevention and smoking cessation efforts.

Automated Identification Of Unhealthy Drinking Using Routinely Collected Data: A Machine Learning Approach, Levi N. Bonnell, Benjamin Littenberg, Safwan R. Wshah, Gail L. Rose

Larner College of Medicine Faculty Publications

Background: Unhealthy drinking is prevalent in the United States and can lead to serious health and social consequences, yet it is under-diagnosed and under-treated. Identifying unhealthy drinkers can be time-consuming for primary care providers. An automated tool for identification would allow attention to be focused on patients most likely to need care and therefore increase efficiency and effectiveness.

Objectives: To build a clinical prediction tool for unhealthy drinking based solely on routinely collected demographic and laboratory data.

Methods: We obtained demographic and laboratory data on 89,325 adults seen at the University of Vermont Medical Center from 2011-2017. Logistic regression, …

Improving Contraception Among Female Syringe Exchange Clients: A Reproductive Needs Assessment, Gena Zollman

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

Purpose: Women with opioid and other substance use disorders have a high rate of unintended pregnancy and a low rate of effective contraceptive use. Integrating family planning (FP) services into medication-assisted treatment (MAT) clinics has increased rates of initiation and adherence to contraception among this population. This study assesses the reproductive health needs of female clients in a syringe exchange program (SEP)to assess if integrating FP services would improve access to contraception.

Methods: Female clients of a SEP voluntarily completed an anonymous survey to determine demographics, FP needs, and barriers to accessing care, and were compensated with $20 gift cards. …

Improving Health Literacy Among Latino Migrant Dairy Farmworkers, Dayna A. Stimson

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

Background/Purpose: Latino migrant farmworkers are a marginalized and medically underserved population in Vermont and nationally. They experience significant health disparities and barriers to healthcare access compared to others living in rural areas. Barriers include limited knowledge regarding available services and low general and health literacy. These barriers lead to poorer health outcomes. The purpose of this evidence-based project was to enhance health literacy and follow-up care for migrant farmworkers by improving health literacy in a community health outreach setting.

Methods: In northwestern Vermont, 33 outpatient migrant farmworkers were recruited following health screening visit and referred for follow-up. AHRQ …

Implementation Of A Chronic Pain Functional Assessment Tool In Primary Care Practice, Jude Emerson Stevens

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

Background

An estimated 20% of patients with non-cancer pain symptoms or pain-related diagnoses receive an opioid prescription. Current guidelines advocate use of a functional assessment as a strategy to improve the efficacy and safety of chronic pain management using opioids. This project aimed to integrate functional assessments into patient care visits for chronic pain and optimize safe and effective prescribing.

Methods

This quality improvement project was conducted at a primary care clinic in Burlington, VT. Baseline data on current functional assessment utilization and barriers amongst providers were collected. The validated Pain, Enjoyment, and General Activity (PEG) scale was administered from …

Improving Cardiac Arrest Outcomes With Hands-Only Cpr, Ethan Witt

Family Medicine Clerkship Student Projects

Bystander CPR is one of the most effective and necessary components of cardiac arrest management, increasing survival rates by two to three times. However, rates of bystander CPR are inadequately low. Hands-only CPR has been found to be an effective intervention in the management of cardiac arrest and addresses many of the barriers to bystander CPR.

Association Of Sickle Cell Trait With Exertional Rhabdomyolysis And Atrial Fibrillation., Daniel R. Douce

Graduate College Dissertations and Theses

Sickle cell trait (SCT), sickle cell disease’s carrier status, is a common genetic variant found in many people of African, South Asian, Middle Eastern and Mediterranean descent. While overall considered a benign carrier status, it has been associated with an increased risk of several diseases, including exertional rhabdomyolysis (ER), and chronic kidney disease. While epidemiological evidence links SCT with ER, the actual pathophysiological mechanism less understood. Additionally, while there is an increased prevalence of atrial fibrillation (AF) documented in people with sickle cell disease, studies in individuals with SCT are lacking.

The objectives of this thesis are twofold: The first …

Referral Patterns And Service Provision In Child Protective Services: Child, Caregiver, And Case Predictors, Hannah Mead Holbrook

Graduate College Dissertations and Theses

Child maltreatment, and recurrent maltreatment in particular, occurs at an alarmingly high rate. Frequency of reports to Child Protective Services (CPS) is associated with negative psychological outcomes, and children whose reports are unsubstantiated experience similar risk of behavioral, emotional, and substance use disorders as those whose reports are substantiated. Prior research has demonstrated that children with no CPS reports and children with one CPS report showed no significant differences in rates of maltreatment perpetration or substance use in adulthood, suggesting that prevention efforts after one report may have strong merit in reducing negative outcomes in adulthood. However, patterns and risk …

An Analysis Of Beverage Consumption In The United States Using The National Health And Examination Survey 2007-2017, Sean Morris

Graduate College Dissertations and Theses

Sugar-Sweetened Beverages (SSBs) are liquids sweetened with various forms of added sugar. They are the leading source of calories and added sugar in the American diet (Drewnowski & Rehm, 2014; National Cancer Institute, 2016; Powell, Chriqui, Khan, Wada, & Chaloupka, 2013). The health and nutrition literature has increasingly identified added sugars and SSBs as a key potential contributor to a host of public health issues including obesity, type 2 diabetes, hypertension, and cardiovascular disease (Johnson et al., 2009; Malik, Popkin, Bray, Despres, & Hu, 2010; Vartanian, Schwartz, & Brownell, 2007). Concern about these public health crises has recently animated regional …

Vermont Hospitals' Emergency Department Utilization Charges By Insurance Payer, Caitlin Beaudet, Catriona Brosius, Jennifer Campbell, Owen Greene, Brittany Lapan, Amara Mackillop, Thomas Delaney, Barbara Carroll Edd

Master of Public Health Culminating Projects

Objective: To identify the differences in emergency department (ED) charges across all insurance payers and to evaluate ED charges for Medicaid beneficiaries over time.

Methods: The Vermont Department of Health's publicly-available Hospital Discharge Data Set (HDD) data for 2012, 2014 and 2016 was analyzed by insurance group and year, as predictor variables, with age and sex as covariates. The primary outcome variable was total charges as a binary variable.

Results: Medicare cases had the greatest odds of high total charge visits. The odds of Medicare records having high total charges were 65.0% greater than the odds of Medicaid records having …

Life's Simple 7 And Health Care Utilization Among The Framingham Generation Iii Cohort, Elizabeth Cooley, Courtney Williams, Nels Olson, Caroline Nwaro, Jules Wetchi, Joe Collier, Jan K. Carney Md, Mph

Master of Public Health Culminating Projects

Abstract

Objective: To evaluate associations of cardiovascular health status with utilization of healthcare services.

Methods: Our study included 3,786 participants from the Framingham Third Generation Cohort (enrollment: May 2008 – February 2011). LS7 0-14 point summary scores were categorized as “suboptimal” (score of 0-7) and “optimal” (score of 8-14). Participants were stratified into two utilization groups. Those with 0-1 utilizations were compared to those with 2 or more visits ("Super Users”). Logistic regression was used to estimate associations of the two LS7 categories with the odds of "Super User" utilization (models adjusted for age, sex, race, and education).

Results: Compared …