The What’s, Where’s, and Why’s of What Your Family Eats: The Burlington Children’s Space Farm To Table Program
Loren Babirak, Kelly Cunningham, James Dunlop, Jenny Nguyen, Cheddhi Thomas, Zea Schultz, Michael Visker, Nancy Drucker, and Barbara Frankowski
Introduction: Preventing childhood obesity is a national priority, and changing dietary behavior in both children and adults is challenging. Burlington Children’s Space, Inc. (BCS), a private, non-profit early education and childcare center providing services for families in the Burlington area, is trying to do just that. The Farm to Table Project was designed to positively influence the food choices of students and their families as well as to cultivate a relationship between families and local farmers. In an effort to secure expanded funding for the school’s food program, BCS requested that we assess the effectiveness of their Food Program
Assessing the Current State and Potential Needs of the Community for Autism Spectrum Awareness in the Classroom
Megan Berube, Adam David, Shannon DeGroff, Sharif Nankoe, Kaitlin Petros, Steven Schaub, Scott Wasilko, Deb W. Lyons, and Stephen Contompasis
Introduction: • Number of children with autism and related disorders has been growing in Vermont in the last ten years. • Puppets in Education, Inc (PiE) recently added a new program Friend 2 Friend Programs-Vermont (F2F), that will work with grades K?8 to educate students and teachers about autism spectrum disorders (ASD). • Goal is to promote understanding, acceptance, empathy and mutual friendships between children with ASD or other social communication disorders • Students from the University of Vermont College of Medicine partnered with PiE to evaluate the current needs of the community, determining what information would be most useful in the F2F program.
Marissa Bucci, Katie Casas, Emily Colgate, Holly Gunyan, Lincoln Heath, Matthew Hoffman, Ryan Smith, Bill Bress, Razelle Hoffman-Contois, Jan Carney, and Charles Hulse
Introduction: Bisphenol A (BPA) and phthalates are chemicals used in the production of many plastics, including food containers, water bottles, and medical intravenous tubing. These chemicals can leach from the plastic, especially when heated, and are found in varying concentrations in the human body. There is concern about the widespread exposure to BPA and phthalates since studies indicate they may cause adverse health effects, particularly related to endocrine development and regulation in young children.
Patrick O. Butsch, Laura C. DePouli, Nicholas A. Larochelle, Mckalyn G. Leclerc, Michael A. Maccini, Michael P. Morwood, Andrea M. Steely, Virginia Hood, George Phillips, William Wargo, Tom Delaney, and Jan Carney
Background: The Vermont legislature (bill H.435, Sec. 19) has tasked the Vermont Board of Medical Practice (VBMP) with making a formal recommendation on improving Vermont health professionals’ knowledge and practice of Palliative Care and Pain Management (PC/PM). In collaboration with the VBMP, our group set out to answer the following questions: • How confident/competent are VT physicians in the practice of PC/PM? • What are the barriers to achieving optimal patient care in PC/PM? • Do VT physicians believe mandatory CME would improve the overall quality of care in PC/PM? • What are the best methods of providing Continuing Medical Education (CME)?
Carl Cappelletti, Lindsay Corse, Aaron Kinney, Suleiman Lapalme, Nolan Sandygren, Danielle Scribner, Mariah Stump, Tom Delaney, Margaret Holmes, Molly Dugan, and Patricia Berry
Background: Older adults have unique nutritional needs due to physiologic changes that occur as part of the normal aging process. Maintaining adequate nutrition has the potential to reduce morbidity and mortality related to chronic disease, fall risk, dementia and Alzheimer’s disease. Aging also poses an increased risk of isolation and lack of social interaction, particularly noted at meal times. Unintentional weight loss is an independent risk factor for early mortality. Social eating is related to higher food intake, and meal programs can improve nutritional risk for vulnerable seniors. We partnered with the Cathedral Square Corporation (CSC) to assess nutrition and social eating in residents at Heineberg Senior Housing in Burlington, VT and conducted focus groups to determine general nutritional concerns and evaluate potential interventions.
Daniel Carballo, Anne Kamarchik, Lindsay Nadeau, Isaac Noyes, Marianne Reed, Louisa Salisbury, Nathaniel Ward, Rob Meehan, and Jan Carney
Introduction: Food insecurity is a household-level economic and social condition of limited access to nutritionally adequate and safe food. Food banks provide a major source of sustenance for individuals experiencing food insecurity, many of whom deal with obesity, diabetes and hypertension, however, the nutritional contents of many donations to these operations fail to meet the dietary recommendations set forth by the USDA for individuals with many chronic health conditions. In the present economy there is increasing demand for the services of local food shelves, however, often these organizations are unable to sufficiently meet the needs of their clients with regard to quantity ,and perhaps more importantly, the nutritional quality and variety of food available. One cause of the lack of nutritionally rich donations is poor public education about the needs of the food shelf and its clients. This study seeks to determine if consumer education at the point of purchase can influence donation decisions to increase the quantity and improve the nutritional quality of items donated to the Chittenden Emergency Food Shelf in a sustainable and reproducible manner.
Martha Choate, Francisco Corbalan, Mei Frankish, Semeret Munie, Jessie Kerr, Jonathan Nucum, Thomas Pace, Thomas Delaney, Wendy Carty, Colleen McLaughlin, and Robert Karp
Background: While alcohol misuse is largely a problem reported in younger populations, recent studies have shown that it may be a significant, under-reported and under-diagnosed problem in the senior population. Alcohol misuse in this population is further confounded by its association with serious co-morbidities including falls, confusion, and reactions with medications. These problems can be difficult to identify in the aging population, as they may be mistaken for dementia, depression, or other illnesses. Even less studied than alcohol use patterns in the general elderly population are the prevalence and patterns of alcohol use in senior care facilities. In Chittenden County, Vermont, these facilities appear to vary widely in how they identify and assist residents with alcohol misuse issues. Understanding their policies will be an important step towards developing effective strategies for reducing alcohol misuse among residents. The importance of understanding and identifying alcohol-related problems in the elderly is critical as the aging population in this country continues to grow. Proper intervention has the potential to have a real impact; studies have shown that older people have a greater ability to adhere to treatment plans than those in younger age groups, which may contribute to treatment success
Andrew Erb, Patrick Huffer, Tri Luu, Elizabeth Mebrate, Alyse Rymer, Eleonore Werner, Eric Worthing, Hal Colston, and Halle Sobel
Introduction: Maintaining a nutritious diet and physical activity is a challenge for many people,but especially for those with limited financial and social resources. Barriers to adequate exercise and healthy food include prohibitive costs of gym membership and high quality foods, lack of time during the day in which to exercise or prepare meals, and lack of access or transportation to exercise facilities or grocery stores. We assessed whether adoption of healthy exercise and eating habits could be established and sustained by educating participants on healthy diet guidelines and on non-traditional exercise forms. We encouraged family-centered activities such as walking, gardening, cleaning, dancing, and playing with children. We quantified changes in participants’ pre- and post-educational diets and exercise habits with 3-day dietary recall logs and pedometer-measured daily steps.
Piyush Gupta, Benjamin King, Katherine McBride, Damoon Rejaei, Jennifer Springer, Tyler Stewart, Diana Swett, William Pendlebury, and Linda Martinez
Background: As the population of elderly citizens in the U.S. continues to expand paralleled by an increase in the prevalence of dementia, the role of respite care within the healthcare system will increase in importance. Respite care is defined as providing the primary caregiver with relief, or a reprieve, from care commitments on a short-term or emergency basis. The need for caregiver respite is well-documented; has been shown to decrease emotional stress,burnout, anxiety and depression; and is considered vital to the overall well-being of the caregiver. While studies have shown that respite care is effective, there is an unmet need for more flexibility in existing programs to improve utilization rates and availability. We attempted to address this issue by adapting an existing model to increase respite care options available to caregivers in our region.
Referral Patterns Between Allopathic Physicians and Complementary and Alternative Medicine Practitioners: A Followup Study
Molly Hubbard, Hany Khattab, Matthew LeComte, Lindsay Peet, Meghan Small, Khine Win, Asha Zimmerman, Margaret Eppstein, Helene Langevin, and Phil Trabulsy
Introduction: • Despite the high prevalence of Complementary and Alternative Medicine (CAM) usage, several recent surveys suggest that the vast majority of patient visits to CAM practitioners are self-referred and that communication between conventional and CAM practitioners is limited. • There is a need for a better understandingof factors influencing referral patterns across these two groups of practitioners. • Network analysis provides a useful tool to quantify relationships between members of an interrelated social network. • The goal of this follow up study was to quantify the cross-class referral patterns between conventional and CAM classes of practitioners in Chittenden County Vermont as well as gather additional information on the basis of referrals for future studies. • This study was a preliminary examination of possible reasons for the referral patterns.
Assessing Health Concerns & Obstacles to Diesel Exposure Reduction in Vermont Diesel Vehicle Operators
Melissa Marotta, Renee Bratspis, Maria Furman, Brett Porter, Joseph Yared, William Timbers, Quillan Huang, Rebecca Ryan, Gerald S. Davis, and Jan Carney
Background and Objectives: Diesel vehicle idling reduction is an important national environmental and legislative issue. Exposure to diesel exhaust is associated with significant morbidity and mortality, including: • Lung & esophageal cancer • Asthma • Cardiovascular disease • Neurotoxicity • Decreased sperm count & testosterone deficiency Drivers of diesel vehicles have specifically been shown to have increased incidence and death from lung cancer. Diesel engines emit a number of known hazardous chemicals, including carbon monoxide, nitric oxide, sulfur dioxide, benzene, formaldehyde, and acrolein, into the air supply. While public health efforts to reduce diesel idling in Vermont and elsewhere have identified employers’ significant financial incentives in fuel conservation, perhaps there is also a role for appealing to drivers themselves: the people who are incurring the most direct exposure. It is unknown, however, whether Vermont diesel vehicle operators are aware of the health effects of diesel exhaust – or, more significantly, whether they are concerned about it. In order to identify potential targets for future interventions to reduce diesel idling in Vermont, this study aims to probe the following: • Have Vermont drivers been educated about exhaust exposure? • Are they concerned about potential health effects of diesel? • Are they satisfied with their understanding of the health impact of diesel fuel? • What are their health concerns, more generally? • What resources for health information do they respect? • What are their specific obstacles to idling reduction?
Jessica Andrews, Alycia Horn, Christian Sanchez-Jordan, Amos Shemesh, Jeremy Silver, Tara Song, Katherine Wang, Al Robinson, and Marianne Burke
Background/Introduction: Vermont was ranked the nation’s healthiest state, according to 2007 America’s Health Rankings. However obesity, currently the second most common cause of death among VT adults, is becoming so common it may replace cigarette smoking as the number one risk factor for death. In fact obesity affects 21% of adults in VT, most commonly low income adults. Obesity is a risk factor for high cholesterol, high blood pressure, heart diseases, and diabetes. Diet quality and physical activity are important factors in preventing obesity. 42% of Vermont adults are below the recommended level of physical activity. Greater knowledge about nutrition correlates with improved diet quality and greater physical activity. A successful educational strategy on physical activity and nutrition promotes group activities and adapts for cultural relevance.
Claire Ankuda, Ben Kelmendi, Phillip Lam, Amy Odefey, Mimi Ogawa, Chase Petersen, Emily Schonberg, Jon Bourgo, and Rodger Kessler
Introduction: Vermont has programs to assist low income individuals in obtaining basic needs such as health insurance, food security, fuel assistance, housing and transportation. However, these services are often underutilized by eligible individuals. Major barriers to enrollment include lack of knowledge about available programs and their income cutoffs, cumbersome application processes, literacy barriers, and lack of transportation to application sites. In other states, efforts to reduce these barriers have included shortened application forms, removal of asset tests, mail-in applications, media outreach, and eligibility workers placed in outreach agencies. Many studies suggest that the presence of an eligibility worker at a community health center can help overcome some social service enrollment barriers.
Promoting Physical Activity in Local Communities: Understanding Health, Nutrition, and Physical Activity Needs in Winooski, VT
Nicholas Aunchman, Anna Bovill, Garret Fidalgo, Oli Francis, Tara Goecks, Sarah Guth, Vandi Ly, Pam Farnham, and Kevin Hatin
Introduction: Since the Winooski YMCA opened in March 2008, enrollment has been much lower than expected, with only 200 members enrolled by September 2008. One goal of the YMCA is to promote the health of the community by increasing involvement in physical activity in Winooski. Regular exercise is associated with enhanced health and decreased risk of diabetes, cardiovascular disease, as well as many cancers. In order to promote physical activity in the Winooski community, the YMCA set a goal to increase their enrollment to 500 members by December 2008.
Elizabeth Baker, Matthew Meyer, Asya Mu’Min, Lindsey Oliver, Daniel Oppenheimer, Steven Perrins, Whitney Young, Razelle Hoffman-Contois, William Bress, and Jan Carney
Introduction: •The average annual temperature in Vermont has gradual increased roughly 1° Centigrade with an increase of 1.16 inches of annual precipitation over the past 112 years. •According to expert analysis, humans are responsible for 60% of the warming overthe past 140 years. •Projected greater than 1° Centigrade increase in global temperature by 2100 and a correlated rise in precipitation. •Climate changes result in the introduction and reproduction of non-endemic flora and fauna. •Vector-borne diseases accompany warming trends and can become endemic and cause new illnesses in areas which were previously uninhabitable.
Dino Barhoum, Joanna Conant, David Diller, Annya Fischer, Marisa Hori, Hunter Moore, Kathryn Richard, Colin Robinson, Burton Wilcke, and Jan Carney
Background: The societal impact of Paid Sick Days (PSDs) has not been fully addressed in Vermont. Evidence suggests that PSDs benefit the well being of the employee in addition to saving expenses for the employer and the state. PSDs prevent the spread of diseases such as influenza and allow the ailing individual to receive proper medical attention. Inadequate PSDs not only affect the individual who needs time away from work due to illness, but extend to their entire family. Studies have documented the adverse effects from lack of PSDs on the ability for parents to care for their child. The following facts are known: • 7 states require private sector employees to provide “flexible” PSDs for family members (Vermont does not). • 66% of employers in Vermont do not provide PSDs for their employees. • Parents with PSDs or vacation are 5.2 times more likely to take time off from work to care for their sick child. We hypothesize that elementary aged children of working parents, who have an insufficient amount of PSDs, are more likely to attend school with an acute illness and are more likely to receive inadequate health care (i.e., miss well child check ups).
Jessica Barry, Jennifer Kneppar, Timothy Salib, Jonathan Severy, Bennett Shapiro, Kathryn Skelly, Kara Tweadey, Rebecca Ryan, and Gerald Davis
Introduction: Important public health policy decisions must be based on reliable epidemiologic studies and evidence-based medicine. In the effort to ban smoking in the workplace, there must be clear evidence from the constituency that such laws are desired. Current Vermont law states: "Employers may designate up to 30 percent of an employee cafeteria or lounge as a smoking area and may permit smoking in designated unenclosed areas only if … smoking will not be a physical irritant to any non-smoking employee, and 75 percent of the employees in the designated areas agree to allow smoking." State legislators must address this issue for several reasons: * Long term effects including lung cancer, emphysema, heart and neurologic disease. * Secondhand smoke contains at least 250 chemicals known to be toxic, including more than 50 that can cause cancer. * The total cost of secondhand smoke exposure in the U.S. at $10 billion annually, $5 billion in direct medical costs, and $5 billion in indirect costs such as lost productivity. * Methods to reduce the effect of secondhand smoke, such as ventilators are ineffective. * One study found a 17% increased risk of developing lung cancer with smoking exposure in the workplace. Regardless, Vermonters continue to smoke; as of 2007, 18% of Vermont’s adults were smokers. Such information is important in making legislative decisions that affect the entire Vermont population
Angus Beal, Hannah Caulfield, Elizabeth Cipolla, Theodore Elsaesser, Andrew Gagnon, Megan Gossling, Yangseon Park, Jill Jemison, Annika Hawkins, and Mary Anne Kohn
Introduction: Low income individuals are faced with numerous barriers to health care that can lead to worse health outcomes. Limited access to transportation, in particular, has been linked to lower rates of doctor’s visits and consequently, a greater burden of disease. Community agencies such as Safe Harbor (SH), the Community Health Center (CHC), and the Committee on Temporary Shelter (COTS) in Burlington, Vermont reported the move of many ambulatory care practices from Fletcher Allen Hospital, located on a citywide bus route, to Tilley Drive, which was not located on a bus route, as a significant barrier for their patients.
Erin Beardsworth, Kelsey Davidson, Andrew Fanous, Rebecca Gordon, Brian Kilonzo, Isaac Leader, Jason Shen, Tania Bertsch, and Debbie Dameron
Background: The utilization of mammography has been shown to be lower in socioeconomically disadvantaged groups, which includes the African refugee community in Vermont. Mailed letters, telephone reminders, and massive media campaigns have proved ineffective at increasing rates of mammography screening in socioeconomically disadvantaged populations. However, a promising method to increase mammography screening is the use of peer educators to conduct home visits or group educational sessions. The Association of Africans Living in Vermont (AALV) has trained peer educators from the African community, known as Lay Health Educators (LHEs), to help increase mammography screening in this population.
Rachel Bell, Francois Coutu, Robert Johnston, Brendan Kelley, Shailen Mhapsekar, Jane Roberts, Heather Viani, Jennifer Hunter, Tom Delaney, and Patricia Berry
Background: Aging is associated with numerous risk factors for declining physical and mental health. As a result, many elder individuals are forced to relocate to nursing homes, assisted living centers or just closer to adequate medical facilities. Studies have shown: • Relocation of elders is associated with depression, anxiety, memory loss, and decreased social adjustment and life satisfaction • Persistently lonely people exhibit a 2-fold greater risk for developing Alzheimer’s disease (AD) than those who are not chronically lonely • Increased social interaction improves cognitive function in individuals with AD By helping seniors to age in place, many of the deleterious risks of relocation, such as social isolation, depression, and cognitive decline could be avoided. In addition to relocation, other risk factors that affect cognition have been identified: • Physical activity is associated with higher cognitive functioning in elders • Polypharmacy is a risk factor for impaired cognition Thus, simple modifications that allow seniors to age in place may reduce morbidity and enhance quality of life. Cathedral Square Corporation (CSC) is a non-profit organization whose mission is to develop, manage, and own housing that provides community services to promote the health and well-being of elders, low income persons, and persons with disabilities. Students from the University of Vermont College of Medicine (UVM) partnered with CSC in a project to promote aging in place via evaluation of seniors’ current needs and the development of a service model to meet these needs at home.
Aaron Bos, Lawrence Dagrossa, Rachel McEntee, David Morrow, Erin Perko, Anthony Vu, Jennifer Wlodarski, Caroline Homan, and Robert Luby
Background: Organic food is the fastest growing sector of the U.S. food market. It is a common belief that organic food is healthier and more environmentally friendly when compared to food grown and processed conventionally. Despite presumed benefits, our objective was to answer the following questions: • Why do consumers choose organic, especially when faced with a higher average price? • Is there scientific evidence that organic foods are healthier than their conventional counterparts? This project built on a previously conducted demographic and shopping habits survey by our partner agency, City Market, of Burlington, VT.
Benjamin Briggs, Alan Frascoia, Vadim Petrov-Kondratov, Shayna Rivard, Phan Thai, Lauren Wendell, Matthew Williams, Carol Dembeck, Peter Nattress, R Wilson, Mark K. Fung, and Jan Carney
Introduction: Declining blood collection endangers the blood supply at a time when the health care system is requiring an increasingly greater amount of blood products. Blood donation centers are challenged to recruit and develop first-time donors into reliable repeat donors, thereby ensuring a sufficient blood supply. Communication strategies such as e-mail reminders have been shown to be an effective communications tool to promote blood collection. Alternatively, Text Messaging has been shown effective in primary care and preventative medicine. Text messaging improved patient compliance with a schedule of vaccine dosing, as well as improving patient attendance at outpatient clinics. Additionally, text messaging reminders have been shown to be as effective as phone reminders in increasing patient attendance at outpatient appointments. Finally, text messaging has been shown to be useful for managing self-care such as smoking cessation, monitoring asthmatic symptoms, and diabetes control. We investigated whether offering the use a text message reminder to donors would increase attendance at donation events, demonstrating that text messaging can be an effective tool in maintaining a pool of blood donors.
Theresa Duong, Andrew Eyre, Ari Garber, Abby Gross, Melissa Hayden, Joshua Kohtz, Julie Lange, William Wargo, Virginia Hood, and Jan Carney
Background: Physicians today need a working knowledge of pertinent medical law. With an increased focus on patients’ rights in health care, states are encouraged to set specific laws protecting patients. The additional medical legislation places a challenge on physicians to continually update their medical-legal acumen such as disease reporting, malpractice issues, and medical information access.Little research has been conducted on physicians’ knowledge of the law and medicine. In an effort to expand upon these topics and to find an efficient way to make information about the law and medicine accessible to Vermont physicians, the University of Vermont College of Medicine partnered with the Vermont Board of Medical Practice to answer the following questions: • How well do Vermont physicians understand laws that relate to the practice of medicine? • How do Vermont physicians access nformation on law and medicine? • What topics are most relevant and important to Vermont physicians? • What educational methods willbe effective and how can the Vermont Board of Medial Practice best serve such education needs?
Referral Patterns Between Allopathic Physicians and Complementary and Alternative Medicine Practitioners
Dan Gale, Shohei Ikoma, Quinn Meisinger, Caroline Moats, Jessica Sayre, Marvin Scott, Susan Varga, Mimi Reardon, Helene Langevin, Margaret Eppstein, and Robert Davis
Introduction and Objectives: The provision of basic healthcare in the United States may be viewed considering two different, and sometimes combined, therapeutic approaches: •Allopathic/osteopathic medicine •Complementary and alternative medicine (CAM) Our study is interested in the intersection of allopathic medicine and CAM. Evidence suggests that Americans are seeking CAM at a similar or even a higher rate than allopathic medicine, yet there seems to be a division between practitioners of each discipline. Isthis division created by a lack of coordination, such as an inadequately established referral system, or by a general lack of knowledge, or by the attitudes of the practitioners? In our study our objectives were: ? To assess the referral patterns between allopathic and CAM practitioners in Chittenden County. ? To examine the various factors that may influence these referral patterns using confidential surveys.
Patrick Hackett, Elizabeth Lagana, Metasebia Munie, Sinan Ozgur, Heather Provencher, AmiLyn Taplin, James Ware, Sarah Russell, and Amanda Kennedy
Background: • 23.6 million people or 7.8% of the US population have diabetes • Type 2 diabetes can cause many serious problems that affect the heart, nerves, eyes, and kidneys • Lifestyle choices, including dietmanagement, can be used to control or help supplement medical care used in minimizing the risk factors associated with diabetes