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Examining The Feasibility Of Integrating An Alcohol Detoxification Protocol Within Primary Care, Emily A. Miller, Dnpc, Bsn, Rn

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

Purpose: Medically supervised, in-home alcohol detoxification is safe, efficacious, cost-effective, and satisfying for patients. However, it remains underutilized within primary care practices. This feasibility study aimed to examine clinician perceptions of adopting a standardized outpatient alcohol detoxification protocol at a rural primary care clinic where no internal protocol exists.

Methods: An ambulatory alcohol detoxification protocol was created using the American Society of Addiction Medicine guideline on alcohol withdrawal management and presented to 38 providers and 11 nurses. Twelve participants (six providers and six nurses) completed a modified version of the Implementation Process Assessment Tool. The instrument measured stakeholder perceptions of …

Bayesian Experimental Design For Control And Surveillance In Epidemiology, Bren Case

Graduate College Dissertations and Theses

Effective public health interventions must balance an array of interconnected challenges, and decisions must be made based on scientific evidence from existing information. Building evidence requires extrapolating from limited data using models. But when data are insufficient, it is important to recognize the limitations of model predictions and diagnose how they can be improved. This dissertation shows how principles from Bayesian experimental design can be applied to surveillance and control efforts to allow researchers to get more out of their data and direct limited resources to best effect. We argue a Bayesian perspective on data gathering, where design decisions are …

How To Analyze Parental Conversation Online: A Computational Stack For Studying Vaccine Hesitancy., Carter Willets Ward

Graduate College Dissertations and Theses

Despite national and international organizations such as the CDC and WHO recognizing the value of vaccines and their importance in addressing public health concerns, there has been a decline in coverage for even the most established vaccines over the past three years. The global COVID-19 pandemic has contributed to this decline via decreases in medical resource accessibility and an increase in vaccine hesitancy. Even before the COVID-19 pandemic, WHO had recognized vaccine hesitancy as one of the top ten threats to public health. In the present work, we introduce a background account of (1) vaccine hesitancy and (2) anti-vax activism, …

Low Birth Weight Status Combined With Socioeconomic Factors Influences Future Diagnosis Of Learning Disability, Sinead Donnelly, Nisagini Logendran, Anel Peco, Maris Sagamang, Elizabeth Sparks

Master of Public Health Culminating Projects

Objective: To determine if there is correlation between low birth weight and the development of learning disabilities in later stages of life.

Methods: Data from the National Child Health Survey from 2018-2020 was used with data from

59,963 U.S. households looking at children aged six to eleven years. A multiple linear regression model was used to assess the relationship between low birth weight (<2500g) and learning disabilities and developmental delays when controlling for ethnicity, family structure, and household income.

Results: The results indicate 7.2% of those surveyed reported a child with a diagnosed learning disability. In response to the low birth weight category, 8.2% of the children involved were in the category …

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 …

Cardiovascular Disease Deaths Of Vermonters Aged 65+ Years By Rurality Status Of Residency, Francene Zavala, Katherine Rampone, Kailene Cruden, Tyler Flores, Mark Gauthier

Master of Public Health Culminating Projects

Objective: To analyze cardiovascular disease (CVD) mortality amongst individuals 65 years and older living in different areas of Vermont.

Methods: Using the state of Vermont's Electronic Death Registration System, the cross-sectional analysis compared the rate of CVD death for older Vermonters in urban and rural areas between 2015 and 2019.

Results: The binomial logistic regression model demonstrated statistically significant findings among the predictor variables: rurality (p

Conclusions: These findings suggest a need for increased research and awareness of the impact CVD mortality has among Vermonters 65 years and older in rural areas as this population continues to increase.

Nonlinear Relationships Between The Environment And Health, Levi N. Bonnell

Graduate College Dissertations and Theses

Relationships between the environment and health outcomes are complex and likely nonlinear in nature. However, until recently, most studies used ordinary linear regression to model these relationships. The overall goal of this research was to investigate nonlinear relationships between the environment and health. To accomplish this goal, we used several large, national datasets across varying populations and local environments.

Destination accessibility is an important measure of the built environment that is associated with active transport and body mass index (BMI). In the first study, we sought to determine the relationship between the density of nonresidential destinations (a proxy for walkability) …

Creation Of A Parent-Directed Toolkit To Prevent Youth Vaping, Corinne Webb

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

Purpose: Vaping rates among adolescents are at an all-time high. Misperceptions about the harms of vaping may limit parents’ ability to impact youth vape use. This project developed and tested an evidence-based toolkit to educate parents of adolescents about the risks of vaping.

Methods: The toolkit’s creation was informed by published evidence and multimedia content delineating the scope of the vaping crisis. The toolkit was reviewed and revised by content experts. Pre- and post-implementation assessments were created and tested with faculty members, public health professionals, teachers, and parents. Assessments were utilized to evaluate parental vaping knowledge before and after implementation …

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 …

Socioeconomic Status And Cardiovascular Disease Risk In Vermont Adults, Brenden Green, Abigail Heydenburg, Maryann Makosiej, Shirley T. Plucinski, Julia Slessova, Kayla Donohue

Master of Public Health Culminating Projects

Objectives. To investigate the connection between socioeconomic status (SES) and cardiovascular disease in Vermont adults through the Behavioral Risk Factor Surveillance System (BRFSS) data.

Methods. Data from 4,231 participants from the BRFSS 2019 Vermont survey was used. Education level, income level, federal poverty status, and employment status were used to represent overall socioeconomic status. The study investigated the connection of those variables with a history of coronary heart disease (CHD) and myocardial infarction (MI) to represent overall cardiovascular disease (CVD). Simple and multiple logistic regressions were used.

Results. People aged 65 years or above, who smoke, have high blood pressure, …

Characterizing The Relationship Between Binge Drinking And Condom Use Among Vermont High School Students, Danielle G. Allen, Michael Schwartz, Steph Tack, Robert O'Conner, Madaline Schmidt, Kelsey Gleason

Master of Public Health Culminating Projects

Objectives. To determine if there is a relationship between binge drinking and risky sexual behavior in Vermont high schoolers.

Methods. We used data from the 2019 Vermont Youth Risk Behavior Survey, a survey administered every other year in high schools across Vermont asking students questions about various habits and behaviors. We used binary logistic regression to determine the association between binge drinking in the past 30 days and condom usage at last sexual intercourse.

Results. Binge drinking within the past 30 days was found to have increased odds of students not using a condom during intercourse (OR=0.782) when adjusting …

Bullying And Adolescent Obesity In Vermont High School Students, Lauren Blum, Marlene Colon, Matthew Gilwee, Madeline Leopold, Eva Orr, Thomas Delaney

Master of Public Health Culminating Projects

Objectives. To examine the association between bullying and obesity in Vermont high school students and to provide new insights on effective approaches for mitigating risk of both variables in the public health, healthcare, and teaching professions across Vermont.

Methods. Data came from the 2019 Vermont Youth Risk Behavior Survey (VYRBS) (n = 18,612). We analyzed the relationship between days bullied and obesity, controlling for the confounding effects of risky behaviors. We identified situations that led to increases in both primary predictor variables.

Results. Statistical analysis yielded a significant positive association between days bullied and obesity. Students bullied for 1 – …

Experiences Participating In Federal Nutrition Assistance Programs During The Early Months Of The Covid-19 Pandemic: A Mixed Methods Study In Vermont, Emma Haven Spence

Graduate College Dissertations and Theses

For many Americans, the impacts of the COVID-19 pandemic have extended far beyond its overt health risks, spanning from economic shocks to new social realities. Elevated rates of both novel and continued food insecurity during the pandemic have been well-documented, and this burden has not been equally shared. Examination of food insecurity at the present moment offers a unique opportunity to give voice to those affected during this unprecedented time and understand the ability of existing social services to meet increased needs. This research aims to delve into the experiences of individuals at risk for food insecurity. Specifically, (1) to …

Opioid Overdose Deaths In Vermont: Comparing Rates Of Mortality In Urban Versus Rural Settings, Jamie Bernier, Jonna Thomas, Sindhu Donepudi, Sierra Serino, Mia Crisafulli, Joseph Zamboni

Master of Public Health Culminating Projects

Objective: To investigate differences in opioid-related overdose death in Vermont based on urban versus rural setting.

Methods: A retrospective cohort study was conducted using Vermont’s Electronic Death Registration System from 2015-2019. After applying exclusion criteria, 570 subjects were included in bivariate logistic regression analyses.

Results: Individuals who died in urban areas had 45.8% lower odds of death due to opioid use than those in rural areas. For every one-year increase in age, odds of overdose death decreased by 4.6%. For females, odds of death due to opioid use was 19.4% lower than the odds for males.

Conclusions: Vermont residents who …

Examining The Differences Of External Causes Of Death In Black, Indigenous, And People Of Color Versus The Non-Hispanic White Population Of Vermont, Caitlin Wilson, Yainna Hall, Jennifer Garrigan, Brigid Enright, Abby Erwin, Caitlin Quinn

Master of Public Health Culminating Projects

Objectives: Our objective in this study was to examine differences in risk of death from various external causes between the BIPOC community and individuals who identified as NHW.

Methods: 2015-2019 death certificate data accessible on the Vermont Electronic Data Registration System (EDRS) was analyzed and categorized by external causes of death. Decedent race/ethnicity was assigned as BIPOC or NHW according to the race/ethnicity listed on EDRS. Mortality rates were calculated using binary logistic regression and variable significance was calculated using multivariable logistic regression.

Results: There were varied external causes of death between BIPOC and NHW populations. The risk of external …

Effects Of Gender, Physical Activity, Weight Status, And Mental Health Symptomatology On Primary Care Utilization, John W. Carew, Jaime Cotton, Hannah Shoshan, Alex Gevirtz, Thomas Delaney, Donna O'Malley

Master of Public Health Culminating Projects

Objectives. To determine the association between weight status, gender, physical activity, and mental health symptomatology on utilizing primary care in the last year.

Methods. We used data from the 2019 Vermont Behavioral Risk Factor Surveillance System. We used multivariate logistic regression and X² tests of association to assess factors associated with primary care utilization.

Results. Gender and obese or overweight status are significantly associated with one’s likelihood of utilizing healthcare in the past year. For those with 1-13 bad mental health days, the odds of having utilized healthcare in the past year are 1.65 times greater among women than …

Percutaneous Coronary Intervention In Patients With Acute Myocardial Infarction In A Vermont Hospital 2015-2019: Exploring Associations Between Travel Time And Length Of Stay., Brian Bachyrycz, Tyler Flores, Katie Henderson, Maggie Holt, Joseph Walzer, Caitlyn Dayman

Master of Public Health Culminating Projects

OBJECTIVE: To examine if travel time between patients experiencing acute myocardial infarction (AMI) and a Percutaneous coronary intervention (PCI) center influenced hospital length of stay (HLOS) and discharge destination.

METHODS: Data was extracted from the Vermont Uniform Hospital Discharge Data Reporting System (2015-2019). A logistic regression model examined the association between travel time to PCI center and hospital length of stay (HLOS). Additionally, a χ² test was performed alongside a logistic regression analysis to examine the association between HLOS and patient discharge outcomes.

RESULTS: Logistic regression analysis found no statistically significant relationship between HLOS and travel time from the …

Suicide Ideation And Attempt In Adolescent Vermonters As Related To Perceived Family Socioeconomic Status And Community Sense Of Belonging, Lila Sullivan, Insu Koh, Issy Magbie, Jenna Beckwith, Gabe Mason

Master of Public Health Culminating Projects

Objective

The objective of this study is to evaluate perceived socioeconomic status (SES) and community sense of belonging as risk factors associated with suicide ideation and attempt in Vermont youth.

Methods

Using the 2019 Vermont Youth Risk Behavior Survey, we analyzed the impact that perceived SES and community sense of belonging have on suicide ideation and attempt. Two multiple logistic regression models were used to calculate odds ratio and 95% confidence intervals.

Results

We found significant increases in suicide ideation and attempt with low SES and poor community sense of belonging. The odds of suicide ideation and attempt were 8.47 …

Modeling The Heterogeneous Temporal Dynamics Of Epidemics On Networks, Andrea Joan Allen

Graduate College Dissertations and Theses

Mathematical models of infectious disease are important tools for understanding large-scale patterns of how a disease spreads through a population. Predictions of trends from disease models help guide public health prevention and mitigation measures. Most simple disease models assume that the population is randomly mixed, but real-world populations exhibit heterogeneous patterns in the way people interact. These differences in population structure can be represented by networks. Networks can then be incorporated into disease models by using various interdisciplinary concepts and tools. Yet even network disease models often overlook that populations change over time. In this thesis, two models of infectious …

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 …

Opioid Overdose Deaths In Vermont: Effectiveness Of Buprenorphine Provider Density On Mortality Rates, Noah Chirico, Naw Ruth Doe, Alexandra Mesick, Amy Dubuque, Rachel Cruise, Jan K. Carney

Master of Public Health Culminating Projects

Background

Since 2017, there has been an increase in the frequency of mortality related to opioids in Vermont. Buprenorphine is a great alternative to traditional opioids because of its efficacy in treating opioid use disorder (OUD), however, it is underutilized by providers due to needing a specific waiver to prescribe it. This project looks at two different angles: is the number of Buprenorphine providers associated with the number opioid related deaths per county?; and does a rural setting in Vermont affect mortality rates due to a possible lack of Buprenorphine providers?

Methods

The incidence of overdose deaths per county to …

Associations Between Paternal Mental Health And Child Obesity Using The National Survey On Children's Health, Kerry Morlock, Jenna Nash, Hilary Nardone, Kathleen Bryant, Jennifer Fofi, Kristin Fontaine

Master of Public Health Culminating Projects

Objective: To examine associations between paternal mental health status and childhood obesity outcomes.

Methods: A cross-sectional study was designed from the 2018 National Survey of Children’s Health to analyze potential variance in childhood obesity between paternal and maternal mental health. Multivariable logistic regression was used to determine effects on obesity in 11,394 children aged 10-17 years.

Results: Children of fathers who reported fair or poor mental health had 10% higher odds of being overweight or obese than children whose fathers reported excellent, very good, or good mental health, while controlling for the effects of paternal physical health, and lifestyle, support, …

Chronic Disease And Mental Health In Vermonters, Hannah K. Hunsaker, Katharine Mahoney, Maggie Fein, Beibhinn Anderson, Ana Bistrain, Thomas V. Delaney

Master of Public Health Culminating Projects

Objectives. To examine the relationship between chronic physical health conditions and poor mental health among Vermonters.

Methods. We used cross-sectional data from the 2017 Vermont Behavioral Risk Factor Surveillance System (BRFSS) and ran binary logistic regression models from participant responses in the dataset. Subjects included 6,423 Vermonters randomly selected to answer the telephone-based survey in 2017.

Results. Regression models showed that living with asthma was associated with increased poor mental health days compared to those living without asthma. Contrary to expected results, those with diabetes or coronary heart disease (CHD) were less likely to report poor mental health days than …

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 …

Alcohol Consumption Among Cannabis Users In Vermont, Lara Cushman, Florencia Drumwright, Nawar Kareem, Madeleine Mank, Nicholas Milazzo Ms, Victoria Hart

Master of Public Health Culminating Projects

Objective: To examine the relationship between cannabis and alcohol consumption in Vermont; after the legalization of cannabis in 2018.

Methods: We used Vermont's Behavioral Risk Factor Surveillance System (BRFSS) survey; this data included only participants who had reported alcohol use in the past year (n = 3,781). We used multiple linear regression to compare frequency of cannabis use against days per month of alcohol consumption and binomial logistic to compare regression to the frequency in which cannabis was used against the odds of Heavy Alcohol Consumption (HAC).

Results: We found that low and moderate cannabis users had more days of …

Suicide And Non-Suicidal Self-Injury Among Vermont High School Students: An Analysis Of Associated Health-Behavior Variables, Douglas Michael Lebo, Catherine Markesich, Ida Sargent, Mika Smith, Mariana Wingood, Heidi Hales

Master of Public Health Culminating Projects

Objectives: To determine the prevalence of suicidal ideation (SI) and non-suicidal self-injury (NSSI) among Vermont high schoolers and examine their relationship with health-behavior and demographic variables.

Methods: We used responses to the 2019 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance survey from Vermont high schoolers (n = 18 613) to perform bivariate logistic regression analyses of variables thought to predict SI and NSSI.

Results: In 2019, 14.8% of Vermont high schoolers reported SI in the past year, and 18.9% reported NSSI. Lower grade level, LGBT identity, self-perception as over- or underweight, being bullied, alcohol use, smoking, and …

Associations Between Demographic Factors And Suicide Deaths In Vermont: 2015-2019, Isabelle Tomanelli, Lucy Lincoln, Stephanie Stead, Mary Ryan-Eldred, Nick Martin, Sarah Vose

Master of Public Health Culminating Projects

Objectives. To quantify the complex relationships shared between numerous risk factors associated with suicide among Vermont decedents.

Methods. Vermont Electronic Death Registration System (EDRS) data from 2015-2019 were examined through binary logistic regression analyses to examine demographic variables’ ability to predict death by suicide.

Results. In the analysis of 26,738 deaths, significant predictors of suicide among the 535 suicide decedents included rurality (odds ratio [OR] = 1.043; 95% CI = 1.016, 1.071; P = 0.002), divorce (OR = 1.785; 95% CI = 1,396, 2.281; P < 0.001), and higher educational attainment including associate degree (OR = 1.472; 95% CI = 1.033, 2.098; P = 0.032), bachelor’s degree (OR = 1.686; 95% CI = 1.266, 2.247; P < 0.001), master’s degree (OR = 1.812; 95% CI = 1.162, 2.826; P …