Medicine and Health Sciences Commons^™

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.

Attitudes Toward Informational Health Videos Among People With Intellectual Disabilities, Sydney M. Cardozo, Julie P. Connor, Jake Ermolovich, Tyler A. Harkness Bs, Anneliese Lapides, Jack F. Mangan, Nicole Obongo, Maxwell T. Tulimieri

Public Health Projects, 2008-present

An intellectual disability (ID) can be defined as a limit to a person's ability to learn and function in daily life when compared to an expected level. Due to these differences, a person with ID can face more challenges in daily life, including those that impact their health.

Special Olympics Vermont (SOVT) is an organization that hosts athletic events and competitions for people with an ID. We worked with them to formulate a plan for providing educational resources for people with an ID.

We created educational videos with corresponding one-page pamphlets containing material and imagery that was relatable to the …

Naturopathic Medicine In Vermont's Healthcare System: A Thematic Analysis, Trevor D. Coles, Tayler Drake, Rose Eiduson, Daniel J. Fried, Max C. Hoddwells, Simran Kalsi M.S., Mahima R. Poreddy, Clifford A. Reilly

Public Health Projects, 2008-present

Naturopathic Medicine is a system of health care that utilizes education, natural medicines, and natural therapies to support and stimulate a patient's intrinsic self-healing processes and prevents, diagnoses, and treats human health conditions, injuries, and pain.

There are 5 accredited schools of naturopathic medicine in the US and 2 in Canada. Naturopathic physicians were recognized as primary care providers (PCP) in 2009. There are 355 NDs licensed in VT, and 88 NDs with a VT address. 81% participate in Medicaid.

OBJECTIVE: To explore the role of naturopathic physicians in Vermont's healthcare system

Analyzing The Outcomes Of A Comprehensive Pain Management Program, Alia Johnson, Joshua Kohan, Cole Lutz, Patrick Mcclurg, Grace Merritt, Warrick Sahene, Katie Tang

Public Health Projects, 2008-present

An integrative and comprehensive approach to pain management seeks to advance patient outcomes with respect to quality of life, pain management, mindfulness, and physical function. This biopsychosocial approach is an evidence-based medicine modality that has been executed to be cost-effective and targeted to meet individual patient values. Participants can enroll in integrative pain intervention modalities to treat their chronic ailments; examples include Acceptance and Commitment Therapy, PT, OT, nutrition, reiki, hypnosis and yoga. In a systematic evaluation of integrative health projects, Turk et al. concluded interdisciplinary programs yielded better outcomes than traditional pain treatments.

This project tested the hypothesis that …

Improving The Accessibility And Efficacy Of The Uvmmc Chna To Populations Experiencing Homelessness, Rachel Carpenter, Jamie A. Cyr, William Kim, Megala Loganathan, Weida Ma, Dinukie-Chantal Perera, Sean Taylor, William J. Yakubik Iii

Public Health Projects, 2008-present

Under provisions in the Affordable Care Act, tax-exempt hospitals are required to conduct a triennial Community Health Needs Assessment (CHNA) to identify and prioritize the health needs of the community served. UVMMC is preparing to conduct the 2022 CHNA and is exploring best outreach approaches to marginalized or historically underrepresented populations within Chittenden and Grand Isle counties.

Research Question: What actions can be taken to effectively understand the diversity of needs in the homeless population of Chittenden County?

Hypothesis: The current CHNA incompletely captures how health barriers are disproportionately experienced by the homeless population in Chittenden County.

Goals: Identify best …

Addressing Food Insecurity Within New American Communities In Vermont, Lorena Ayoub, Carl W. Brasch, Aria Elahi, Justin L. Esteban, Juwairiyyah Fatima, Brianna J. Spano, Sean Wang, Erik J. Zhang

Public Health Projects, 2008-present

Food insecurity is defined as not having safe, nutritious, or culturally appropriate foods available, or having limited ability to acquire these foods/uncertainty as to when one can acquire these foods.

Reasons for food insecurity can be multifactorial such as language barriers, unfamiliar foods, and limited information about food environments.As a result, many turn to processed and energy- dense foods, contributing to the development of chronic diseases.

Food banks and local food shelves provide supplemental food assistance to residents and communities in need. However, with diverse New American populations living within the same community, it is challenging to determine which foods …

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 …

Lifestyle Changes In Covid-19 Pandemic And Impact On Modifiable Stroke Risk Factors, Kelly J. Chan

Family Medicine Clerkship Student Projects

Stroke is one of the leading causes of mortality and disability in the USA. Underlying conditions such as hypertension, diabetes and cardiovascular disease predispose an individual to increased risk of stroke. In addition, the Covid-19 pandemic presents many challenges to these patients in terms of active health management and maintenance. A screening tool was developed to assess patient patterns of lifestyle behavioral changes measured by modifiable risk factors for stroke (medical condition management, diet, exercise, and smoking habits).

Community Attitudes Towards Covid-19 Vaccination, John P. O'Keefe

Family Medicine Clerkship Student Projects

Vaccination is a very valuable tool in combating the public health crisis of COVID-19 and will be essential in reducing transmission rates and deaths due to the pandemic. Public willingness to receive the vaccination in large polls has stayed well below the ~95% of the population needed to achieve herd immunity against the virus. Here were survey Vermonters to determine their attitudes towards receiving the vaccine and what sources of information patients use to inform themselves about the different vaccines available.

Emergency Medicine Super Utilizers And The Role Of Targeted Community Paramedicine, Nathan E. Dow

Family Medicine Clerkship Student Projects

Frequent emergency department (ED) users, colloquially known as “frequent fliers,” are a small population that account for a disproportionately large number of ED visits. Depending on the criteria used, ED super users may constitute as little as 1% of the individuals seen through the department, while accounting for up to 60% of the visit volume. There is an associated stress on the 911 system and a public health concern with burdening of already busy emergency departments. Unsurprisingly, ED super users have an associated financial cost. A 2015 Milwaukee area pilot program provided community outreach to only 39 of their well-known …

The State Of Sleep: What Keeps Vermont Up At Night?, Magalie Carey

Family Medicine Clerkship Student Projects

No abstract provided.

Medication-Assisted Withdrawal And Alcohol Use Disorder Treatment In The Ambulatory Setting, Jacob Okie Weiss, Javad Mashkuri Md, Marissa Patrick Aprn

Family Medicine Clerkship Student Projects

Alcohol use disorder (AUD) represents a significant burden of disease in central Vermont, but receives little attention and resources compared to other drivers of morbidity and mortality. As part of a community health improvement project, primary care providers in central Vermont were surveyed regarding current practices and perceived barriers related to the effective treatment of AUD. 69% of respondents reported treating alcohol withdrawal syndrome (AWS) and 83% reported treating AUD. Respondents indicated concern about the safety and efficacy of the medications they currently prescribe and expressed interest in learning about other evidence-based treatments for AWS and AUD. The most frequently …

Community Health Interventions To Reduce The Burden Of Radon-Related Lung Cancer, Benjamin Weaver

Family Medicine Clerkship Student Projects

Exposure to radon is the second leading cause of lung cancer in the United States. One in seven homes in Vermont has elevated levels of radon, but most patients are unaware of radon as a risk factor for lung cancer or that radon testing and mitigation services are available to them. To promote increased testing and mitigation of radon we screened patients presenting to a Family Medicine practice in Vermont about whether they had had these services done in their home. We also developed a patient education resource for providers to give to patients who had more questions about radon …

Increasing Patient Access To Lgbtq+ Healthcare Through Expanding The Vermont Diversity Health Project, Rachel Harrison

Family Medicine Clerkship Student Projects

Numerous studies have documented various disparities in health outcomes and barriers to healthcare access for LGBTQ+ individuals. One major way to combat this is to increase access to healthcare for LGBTQ+ patients and increase provider knowledge of how to best care for them. Through expanding the Vermont Diversity Health Project database of providers and having providers participate in LGBTQ+ Best Practices trainings (both hosted by Pride Center of Vermont), we may reduce LGBTQ+ health disparities in our local community.