Public Health Projects from 2021

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Assessing Cancer Prevention Knowledge During COVID-19 Pandemic

Robert Anthony Adamian, Lily Deng, Nicholas W. Krant, Trevor AR McDonald, Natalie Qin, Ally Sarkis, and Althea Jem Darbin Tapales

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 breast, skin and colorectal cancer.

It has been shown that increased knowledge of colorectal cancer screening leads to increased participation in early screening, which can lead to better overall outcomes.
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, and Rebecca B. Rawlings

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 identify barriers to suicide screening within their practices.
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, and Kristen Wright

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 efficacy of the healthcare system, like many other sectors, the COVID-19 pandemic has resulted in unforeseen challenges. According to a 2020 survey conducted by Home Health Care News, 92% of HHC agencies have lost a substantial amount of revenues due to shortage of resources in addition to an increase in patient and caregiver anxiety.
Motivators for Convalescent Plasma Donors during the COVID-19 Pandemic

Betsy Assoumou, Natalie J. Bales, Amy K. Chang, Hannah K. Cook, Kiana Heredia, and Colby J. Fischer

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 important to explore not only what motivates COVID-19 survivors to initially donate plasma, but also the motivations of repeat donors. By gaining a greater understanding of what these motivators are, we may be able to convert these convalescent plasma donors to regular blood donors.
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, and Erik J. Zhang

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 best fit their needs.

Vermont has welcomed 535 refugees in the last 4 years. Many of these new Americans currently reside in Winooski and Burlington. This study seeks to address the issues of mental health, food insecurity, access to the food shelf, and food preferences within the New American communities located in Winooski, Vermont.
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, and Rhys Niedecker

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.
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, and Devan Spence

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 continuing this practice. These results were compared with internally available data (N=79) at Champlain Community Services (CCS), a specialized employment organization in Vermont serving people with IDD. We quantified health outcomes based on Medicaid standards which include annual wellness visits with a PCP, annual dental visits, and ensuring individuals are up to date on vaccinations. Additionally, we quantified other predictors for general wellbeing including current smoking status and body mass index (BMI).

The results of our study indicated that people with IDD from states that have eliminated sheltered workshops tend to have better health outcomes with notable exemplary outcomes in consumers involved with CCS.

We anticipate the results of this study will assist organizations, such as CCS, by articulating the impact of sheltered workshops on people living with IDD and receiving subminimum wage.
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, and Joaquin Reategui

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 outcomes in rural populations.
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, and Timothy L. Long

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 of these and other strategies to maximize food security for school-aged children nationwide.
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, and Maxwell T. Tulimieri

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 athletes with ID, to inspire positive changes in their health habits.

We hypothesized that if content and material relatable to SOVT athletes were incorporated into health education videos, then athletes would learn more about healthy habits that they could apply to their lives.

We created surveys that evaluated the reception of the educational videos, whether athletes learned from the videos, and if they planned on incorporating what they learned into their lives.
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, and William J. Yakubik III

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 practices and tailor outreach methods to better assess the needs of the homeless population.
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, and Ryan Warner

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, we investigated the potential barriers to accessing and attending fall prevention programs in Vermont.
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, and Clifford A. Reilly

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
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, and Alayna M. Westcom

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.
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, and Paula Tracy

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 devices for Farmers will result in a longitudinal and sustainable increase in produce consumption among low income individuals in VT. We hypothesize such changes will ultimately result in improved health outcomes and decreased burden on Vermont Medicaid systems.
Analyzing the Outcomes of a Comprehensive Pain Management Program

Alia Johnson, Joshua Kohan, Cole Lutz, Patrick McClurg, Grace Merritt, Warrick Sahene, and Katie Tang

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 the UVMMC Comprehensive Pain Program produces beneficial patient outcomes with respect to pain management. We evaluated pre- and post- patient physical function, levels of anxiety, fatigue, sleep disturbance, and social role engagement.

Based on our data, we believe further investigation into the benefits of Integrative Medicine is warranted for the advancement of patient outcomes with respect to pain management.
Food Security in the COVID-19 Era

Dana I. Allison, Alex Cohen, Elena Dansky, Willie Dong, Helen Gandler, Luke Hallgarth, Sarah Kendrick, A Carmola, M Bridges, TV Delaney PhD, and JK Carney MD

Food insecurity is a national issue, one that affected 10.5% of households during some point of the year 2019. Those affected by food insecurity can have their access to food jeopardized due to financial hardship, eating patterns altered to prolong the food available, or various other adjustments including reliance on low-cost food, skipping meals, etc.

The state of Vermont is not immune to food insecurity, with a rate of 11.3% of households in 2018.

The Covid-19 pandemic created an unprecedented shift in daily life, with households having to rapidly adapt to meet newly imposed governmental regulations, including stay at home orders, while maintaining access to food essentials. This changed exacerbated food insecurity in already food-insecure households, while simultaneously creating food insecurity for those previously unaffected. A study focusing on food insecurity in Vermont from March to April 2020 found a 32.3% increase in food insecurity, with 35.5% of food-insecure households being previously food-secure.

This change highlighted not only the growing incidence of food insecurity, but also acknowledged the demographic change seen by newly food insecure households.

While this increase is dramatic and alarming, to our knowledge there is no research looking at the continuation of these trends regarding the impact of the Covid-19 pandemic on food insecurity in Vermont households. This lack of data indicates a need for continued follow up to best inform governmental agencies on both how Vermont households are being affected, and how regulations during summer & fall 2020 impacted the rise in food insecurity. These data will then provide guidance for future action to combat current and future food insecurity.