Medicine and Health Sciences Commons^™

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 …

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 …

Increasing Food Insecurity Screening, Coding, And Referral Among Emergency Department Providers, Jennifer Lee Watkins Bsn, Rn, Dnp-C

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

Background & Purpose. Food insecurity (FI) affects 1 in 9 Vermonters (Feeding America, n.d.), and is associated with many poor health outcomes and healthcare expenses (Malecha et al., 2018). Research identifies emergency departments (EDs) as key settings to address FI in high-risk populations (Cullen et al., 2019), guiding this project to the ED of a Critical Access Hospital and Federally Qualified Health Center. This project intended to increase ED providers’ knowledge and utilization of food insecurity screening (FIS), use of FI billing code Z59.4, and subsequent referral to the Community Health Team (CHT). Specific aims included: identify existing …

Integrating Community Into Middle School Sexual Education, Sierra Miller, Margaret Aitken

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

Problem Statement: Most middle school sexual education does not include parents or community members. Evidence shows family and community attitudes towards sex and sexuality are significant factors in adolescent risky sexual and health practices.

Background: Comprehensive sex education (CSE) reduces risky sexual practices and negative health outcomes. National and local organizations have identified CSE as a public health goal. CSE works best when culturally relevant and the community is involved.

Methods: Interviews with the health educator identified community needs. Resources were created in line with the current curriculum focusing on sex education, its importance, and how to talk about …

Measuring The Impact Of Rise Vt: Evaluating Community-Based Obesity Prevention Initiatives With A Standardized Intensity Score, Brianna K. Johnson Bsn, Rn, Ocn, Dnpc

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

Background. Obesity is a leading cause of morbidity and mortality in the US. Rise VT is a multilevel community-based initiative to reduce obesity. The Community Programs and Policies Intensity Score (CPPI) is a standardized metric to evaluate multisector efforts over time, which has correlated with reductions in childhood obesity.

Purpose. The purpose of this project was to quantify the impact of Rise VT using the CPPI score. A secondary aim was to assess the feasibility of using the CPPI score for ongoing program planning and evaluation statewide.

Methods. Interviews with program managers were conducted to gather data related to …

Evaluation Of Clinician Prescribing Practices For Contraceptive Care: A Quality Improvement Collaboration, Julie Desrochers

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

Purpose: Primary care providers (PCPs) have the training and opportunity to provide contraceptive care. Unplanned pregnancy is a major public health issue for which up to 50% of the population is at overall lifetime risk. Reproductive life planning during healthcare visits can reduce rates of unintended pregnancy, prompting contraception or preconception planning. Studies suggest contraceptive counseling protocols and reproductive intent screening are effective tools. This project compares clinician behaviors with best practices. The purpose is to evaluate preventive reproductive healthcare practices in primary care, identifying opportunities to meet the contraceptive healthcare needs for people of reproductive age.

Methods: PCPs and …

Development Of Hospital-Wide Policy For Pediatric Needle Procedures At An Academic Medical Center, Katherine J. Rose

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

Purpose: Needle procedures are traumatic experiences for pediatric patients, and have been linked to formation of phobias and lifelong decreased healthcare utilization.^1,2 Pain management during needle procedures and hospital wide standardization of needle procedures are known to increase patient satisfaction, while decreasing long-term adverse outcomes related to seeking health care.^3,4 The purpose of this project was to develop a hospital-wide standardized policy for pediatric needle procedures at an academic medical center.

Methods: Those performing pediatric needle procedures were electronically surveyed to identify full spectrum issues regarding adoption of a pediatric needle policy. Based on survey findings …

Screening For Palliative Care Services In An Assisted Living Facility, Maria Delia Crosby

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

Background: Palliative care services remain under-utilized, even as evidence suggests that early palliative care leads to positive health outcomes, reduced ED visits, and substantial cost savings. Barriers include a lack of knowledge of palliative care services in the community, and under-utilization of validated assessment tools, including a symptom checklist. Aims of this project: 1. To determine whether the integration of validated community-based palliative care screening tool in an assisted living setting will identify older adults with unmet palliative care needs. 2. To determine if tool implementation could lead to a referral for palliative care consultation.

Methods: A screening tool developed …

From Evidence To Practice: Promoting Continued And Exclusive Breastfeeding In Rural Eastern Uganda, Katherine Judge

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

Purpose: Malnutrition is responsible for about one third of deaths globally among children under age five. Over 65% of these deaths, often associated with inappropriate feeding practices, occur during the first year of life and disproportionately affect those living in resource poor countries. Breastfeeding has been established as uniquely effective in providing infants with nutrients for healthy growth and development. Ugandan demographic surveys (2016) indicate less than 43% of infants age 4-5 months are breastfed.

Methods: The objective was to equip Community Health Educators (CHEs) with evidence-based practice guidelines for promoting continued exclusive breastfeeding to postpartum women. This project was …

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 …

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 Family Planning And Contraception For Female Inmates In Vermont, Callan Janowiec Fnp

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

Background and Objective(s): Unplanned pregnancies are disproportionately high among female inmates, and incarceration provides a unique opportunity for care may be otherwise difficult to obtain, including reproductive health and family planning services, specifically the provision of contraception. It is known that women are 14 times more likely to initiate contraception if education and services are provided within the prison (Clarke et al., 2006b). Despite decades of research identifying the unmet need, very few prisons around the country provide any sort of sexual health or family planning care to prisoners (Braithwaite, Treadwell, & Arriola, 2008).

Methods: This project involves the creation …

Increasing Pneumococcal Vaccination Among Adults 65 And Older: The Development And Implementation Of A Pneumococcal Vaccine Administration And Documentation Protocol For A Small Primary Care Practice., Marina M. Ecklund

College of Nursing and Health Sciences Nursing Master Project Publications

This project focuses on the development of a protocol to increase administration and documentation of pneumococcal vaccination among patient 65 years and older in a primary care practice setting. The project entails reviewing immunization records of all patients age ≥ 65 years at Appletree Bay Primary Care (ABPC) practice to determine current pneumococcal vaccination rates among the specified age group within the practice. A single trial vaccination clinic was it established in collaboration with the Vermont Family Pharmacy wherein patients were contacted by phone by the primary investigator, informed that they may be due for one or more pneumococcal vaccination …

Master's Project: Burlington Geographic: A Place-Based Landscape Analysis And Community Engagement Project In Burlington, Vt, Sean R. Beckett

Rubenstein School Masters Project Publications

Community health surges when inhabitants share a rich sense of place, a quality emerging when people are deeply engaged in understanding their complex and layered landscape. Wendell Berry advises, “if you don’t know where you are, you don’t know who you are.” But how does a city converge around a collective “where” that authentically represents its diverse stories and perspectives? Answers to this question become tools for growing sustainable communities.

As a program coordinator for the UVM/Shelburne Farms PLACE (Place-based Landscape Analysis and Community Engagement) Program, I orchestrated a city-wide celebration of integrated natural and cultural history called Burlington …