Medicine and Health Sciences Commons^™

Community Resilience In Vermont After The 2023 Flooding Event, Alex Poniz

Family Medicine Clerkship Student Projects

Between July 10th-11th 2023 Vermont experienced catastrophic flooding after receiving prolonged heavy rainfall of up to 9” over 48 hrs. Damage from the 2023 event rivals the historic destruction of Hurricane Irene in 2011 and is exceeded only by the Great Vermont Flood of 1927, an event predating modern flood controls. We collected oral histories from Vermonters to better understand their lived experience of the flood and its impacts, and identifed common themes related to community and individual resilience.

Screening For Ptsd In Veterans And Expanding Awareness Of Ptsd Resources, Audree S. Baroni, Bradford Clark

Family Medicine Clerkship Student Projects

PTSD is a prevalent mental health disorder that is especially prominent in the veteran population. Often veterans go without diagnosis and subsequently without treatment due to lack of awareness, screening, and a stigma they will loose benefits from the VA. This project aimed to identify the number of veterans with PTSD and provide alternative treatment methods for symptom management.

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

Family Medicine Clerkship Student Projects

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

The Political Economy Of Intimate Partner Violence And Crisis Management: An Institutional Ethnography In Rural Vermont, Anna L. Mullany

Doctoral Dissertations

Intimate partner violence (IPV) is a significant public health issue affecting one in four women in the United States. Tasked with addressing IPV, crisis centers can significantly impact women’s health outcomes and approaches to perpetrator accountability and community education. Informed by eight months of field work at a rural crisis center and 40 in-depth interviews, this dissertation investigated how the lives of Vermont women experiencing violence and crisis center work are both shaped by larger social, political, and economic relations within capitalism. Dorothy Smith’s method of institutional ethnography provides an investigative pathway for centering survivor experiences and examining crisis center …

A 2022 Assessment Of Food Security And Health Outcomes During The Covid-19 Pandemic, Ashley C. Mccarthy, Farryl Bertmann, Emily H. Belarmino, Sam Bliss, Jennifer Laurent, Jonathan Malacarne, Scott Merrill, Rachel E. Schattman, Kathryn Yerxa, Meredith T. Niles

College of Agriculture and Life Sciences Faculty Publications

We conducted a Northern New England survey to understand the impacts of the COVID-19 pandemic on food security, food access, home food production, health behaviors, and health outcomes. The surveys were conducted in the spring of 2022 (April-May) with a total of 1,013 adults (598 in Maine and 415 in Vermont) responding to the survey. Key findings include:1. The prevalence of food insecurity remains similarly high to early points in the pandemic, likely driven by inflation and food prices, and long-term impacts from the pandemic. 2. The majority (62%) indicated the recent rise in food prices affected their food purchasing, …

Maine: A Health-Focused Landscape Analysis, Katherine Ahrens Phd, Amanda Burgess Mppm, Mph, Carly Milkowski Mph, Yvonne Jonk Phd, Louisa Munk Mph, Erika Ziller Phd

Population Health

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the …

The Northern Border Region: A Health-Focused Landscape Analysis, Katherine Ahrens Phd, Amanda Burgess Mppm, Mph, Carly Milkowski Mph, Louisa Munk Mph, Yvonne Jonk Phd, Erika Ziller Phd

Population Health

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the Northern …

Vermont: A Health-Focused Landscape Analysis, Katherine Ahrens Phd, Amanda Burgess Mppm, Mph, Carly Milkowski Mph, Louisa Munk Mph, Yvonne Jonk Phd, Erika C. Ziller Phd

Population Health

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the Northern …

New York: A Health-Focused Landscape Analysis, Katherine Ahrens Phd, Amanda Burgess Mppm, Mph, Carly Milkowski Mph, Louisa Munk Mph, Yvonne Jonk Phd, Erika Ziller Phd

Population Health

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the Northern …

New Hampshire: A Health-Focused Landscape Analysis, Katherine Ahrens Phd, Amanda Burgess Mppm, Mph, Carly Milkowski Mph, Louisa Munk Mph, Yvonne Jonk Phd, Erika C. Ziller Phd

Population Health

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the …

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 – …

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 …

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

Family Medicine Clerkship Student Projects

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

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

Family Medicine Clerkship Student Projects

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

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 …

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

Family Medicine Clerkship Student Projects

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

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 …

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 …

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 …