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 …

Together We Learn: Collaborating With Medical Students To Build An Online Anti-Racism Guide, Gary S. Atwood, Kate E. Bright

University Libraries Faculty and Staff Publications

In the summer of 2020, students from the medical school’s Social Justice Coalition asked if the library could support their project to build a digital collection of anti-racism resources. Specifically, they asked if the library could host the collection and purchase relevant materials when possible. The project presented interesting policy and technical issues related to LibGuides, the platform we eventually selected. It also provided educational opportunities for the medical students, staff, and the library. After six months of hard work, we launched the collection, titled “Together We Learn: Resources for Our Journeys in Justice & Inclusion” in December 2020.

While, …

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 …

Emulating Agricultural Disease Management: Comparing Risk Preferences Between Industry Professionals And Online Participants Using Experimental Gaming Simulations And Paired Lottery Choice Surveys, Eric M. Clark, Scott C. Merrill, Luke Trinity, Gabriela Bucini, Nicholas Cheney, Ollin Langle-Chimal, Trisha Shrum, Christopher Koliba, Asim Zia, Julia M. Smith

College of Agriculture and Life Sciences Faculty Publications

Mitigating the spread of disease is crucial for the well-being of agricultural production systems. Implementing biosecurity disease prevention measures can be expensive, so producers must balance the costs of biosecurity investments with the expected benefits of reducing the risk of infections. To investigate the risk associated with this decision making process, we developed an online experimental game that simulates biosecurity investment allocation of a pork production facility during an outbreak. Participants are presented with several scenarios that vary the visibility of the disease status and biosecurity protection implemented at neighboring facilities. Certain rounds allowed participants to spend resources to reduce …

Improving Food Insecurity Screening And Utilization Of Services For Veterans, Elizabeth Farah, Jason Garbarino, Mary Alberty

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

Background: 27% of all veterans are food insecure. From 2018-2020, only 1% of veterans seeking care at the VA in White River Junction, VT were identified as food insecure. As a result, an overwhelming number of eligible veterans are not getting vital resources to become food secure.

Purpose: Provide education to interdisciplinary primary care teams about food insecurity, how to use the screening tool effectively, and what resources are available to veterans both within the VA system and in the community.

Methods: Quantitative data was obtained from the food insecurity screener to determine how many veterans were being screened positive …

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 …

Recognizing Tick Bites And Risk: An Educational Initiative For Summer Camp Nurses, Renée B. Cather Msn, Rn, Cen, Cfrn, Dnp(C), Marcia S. Bosek Dnsc, Rn

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

Purpose: There is a high risk of tick-borne diseases in the summer camp environment. Rapid nursing assessment is essential in identifying camper risk and for the provision of prophylactic antibiotics. The project objectives are to (1) modify the existing evidence-based standing orders for the provision of post-tick exposure prophylactic antibiotics, (2) provide summer camp nurse education, and (3) propose implementation strategies.

Methods: Nurses from fourteen summer camps contracting services from a Northeast pediatric primary care office completed a needs assessment regarding barriers to tick exposure assessment and independent utilization of an existing evidence-based protocol. The existing protocol was revised …

Implementation Of A Toolkit To Improve Education For Hospitalized Diabetes Patients., Taylor Brinkman

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

Background: Deficits in diabetes knowledge and self-management skills contribute to poor health outcomes and higher hospital readmission rates of patients with diabetes. Inpatient diabetes education focusing on survival skills teaching to facilitate safe self-management after discharge is essential. Nursing staff report several barriers to providing quality diabetes patient education.

Methods: Staff nurses at an academic medical center provided diabetes survival skills education to hospitalized patients with T2DM utilizing a created toolkit. Prior to discharge, nurses administered standardized teach-back questions to evaluate patient comprehension. Two-weeks post-discharge, 15-20% of patients were contacted to assess knowledge retention.

Intervention: Staff nurses were anonymously surveyed …

Web-Based Wellness Strategies For Socially Isolated Individuals Experiencing Pain, Casie Snyder

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

Background – Use of integrative health services has been shown beneficial in chronic pain management. The COVID-19 pandemic altered access to integrative health therapies. The recommendations to avoid social contact has led to high rates of social isolation. Social isolation has many negative implications including worsening of anxiety and depression symptoms, and influences on our immune, endocrine, and cardiovascular function. Providing access to such therapies at home from trusted practitioners might help to alleviate pain and stressors commonly associated with social isolation.

Local problem – The aim of this project was to create an online platform that offers integrative health …

Smart Phrase Revision To Improve Primary Care Pre-Visit Planning Workflow, Kelly Dobler

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

Purpose: Preventive care has been shown to improve health outcomes yet is underutilized. Use of Pre-visit Planning (PVP) smart phrases or templates in the EHR improve visit workflow and patient care. This project assessed current PVP smart phrase utilization and implementation of revised PVP smart phrases in a primary care setting.

Methods: Medical providers were surveyed to assess their satisfaction with the current PVP smart phrase. Based on those findings and evidence from literature a revised PVP smart phrase was developed. It was implemented and adapted over a 7 week period using four Plan Do Study Act (PDSA) cycles. A …

Stress Management & Resiliency Training (Smart) For Nursing Students, Lili Martin, Msn, Rn, Pccn, Dnp(C), Marcia Bosek, Dnsc, Laura Foran-Lewis, Ph.D, Rn

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

Background: Baccalaureate nursing students report high levels of stress and anxiety. Chronic stress in nursing students is on the rise and can increase the risk for suicide, depression, burnout, and increased academic attrition.

Objectives: The purpose of this EBP/QI project was to establish baseline stress and anxiety levels for senior baccalaureate nursing students and to evaluate the effectiveness of implementing the Benson Henry Institute (BHI) SMART program with nursing students.

Methods: Senior nursing students (n=32) self-selected into either the control or SMART group. The SMART group participated in 8 weekly 1.5 hour SMART sessions during the fall, 2020 semester. All …

Improving Tobacco Cessation Screening And Readiness To Quit During Medication Assisted Treatment For Patients With Opioid Use Disorder, Monique Poisson Rn, Dnp-C, Jennifer Laurent Phd, Aprn

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

Purpose: Tobacco use disorder is commonly comorbid in patients with Opioid Use Disorder (OUD), yet not always regularly addressed during OUD treatment. The aim of this project was to assess tobacco cessation intervention at a small outpatient medication assisted treatment (MAT) program and improve workflow to standardize care, increase knowledge and encourage tobacco cessation among patients.

Methods: The Plan Do Study Act (PDSA) method of quality improvement was used. Patient medical records were reviewed to assess documentation of tobacco use status and readiness to quit in the electronic health record (EHR). A screening, brief intervention, and referral to treatment (SBIRT) …

A Standardized Web-Based Nursing Curriculum On Safe Infant Sleep Practices – A Vermont Statewide Initiative, Jace Nebeker

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

Background/Purpose: In Vermont and across the country, infants continue to die from Sudden Unexpected Infant Death Syndrome (SUIDS), which in most cases is preventable. Best practice recommendations to safe infant sleep education are available; however, ensuring dissemination of this new information to parents has been challenging. The purpose of this Doctor of Nursing Practice project was to develop an evidence web-based nursing curriculum on safe infant sleep practices for registered nurses working in Vermont community birthing hospitals.

Methods: Current literature on safe infant sleep practices, adult learning principles and nursing education strategies were incorporated into the development of an evidence …

The Impact Of A Pediatric Home Visit Program: A Quality Assessment Analysis, Jenna Durkee, Jean Pelski Phd

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

Background: Bringing a newborn home from the hospital can be a time of excitement, but also stress for new parents. This can include financial strain, lack of sleep, and preparations necessary to care for their new arrival. During this transition time, home visit support has demonstrated decreased parental stress and increased confidence in their new parenting roles. In response to these benefits, a pediatric home visit program holds promise for new parents.

Purpose: This quality assessment project evaluated a pediatric office’s home visit program for parental role and pediatric office satisfaction. Based on the analysis, recommendations for improvement were provided. …

Routine Screening For Binge Eating Disorder In Primary Care, Chantel B. Tousignant, Rn, Dnpc, Jennifer Laurent, Ph.D., Aprn

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

Background: Estimated prevalence of Binge Eating Disorder (BED) in the United States is 2- 3%, and 5% in the primary care setting. BED is associated with multiple comorbidities and is therefore a public health concern. Effective strategies to improve screening, diagnosis and management exist, but are underutilized. This project aimed to enhance BED screening and diagnosis while optimizing disease management. Methods: Routine screening for BED was completed using the 7-Item Binge Eating Disorder Screener. Patients were screened regardless of visit type and follow-up was offered to those screening positive. BED prevalence was assessed pre and post-implementation. Surveys were used to …

Implementation Of Cognitive Testing Via Video-Telemedicine, Lindsay Mills Holland, Rosemary Dale, Mary Val Palumbo

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

Background: Early diagnosis and timely follow-up of cognitive decline are essential to preserve individual function and memory, improve quality of life, and decrease healthcare costs. Many barriers to in-person assessment exist, the most recent one being COVID-19. Video-telemedicine has been studied as a solution with promising results. Most notably, research shows that the Mini Mental State Examination (MMSE) administered via video-telemedicine has comparable results to in-person assessment.

Purpose: The purpose of this project was to implement cognitive testing via video-telemedicine for follow-up management of cognitive impairment and dementia.

Methods: A protocol for conducting the MMSE via Zoom was developed. Next, …

Cooking For Health: An Integrated Approach To Enhancing Food Agency, Rebecca Anne Nagle

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

Cooking for Health: An Integrated Approach to Enhancing Food Agency

Author: Rebecca Nagle, MSN, APRN, PNP, DNP-c

Advisor: Dr Jennifer Laurent, PhD

Mentor: Dr Amy Trubek, PhD

Background: College students have poor food habits and are disproportionately affected by food insecurity. Food agency is one’s ability to provision and cook for themselves. Promotion of healthy eating and food agency for college students has shown to increase their food self-efficacy, improve health, and prevent obesity.

Purpose: Determine the effectiveness of an undergraduate class focused on cooking for health in improving student’s food agency, eating behaviors, and health.

Methods: Undergraduate students participated …

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 …