Public Health Projects from 2023

Follow

• 

  United Way of Northwest Vermont- Mental Health Initiative

  Julie Adelman, Jake Bleau, Jeyna Doshi, Devin Hebert, Angela Khadka, Shani S. Legore, and Ryan Trus

  Background: Mental healthcare has become a top priority in Northwest Vermont. However, capacity issues and other barriers limit access to appropriate and timely services. We developed a Sequential Intercept Model (SIM) map to allow stakeholders to understand how individuals from Chittenden County move through the continuum of the mental health system at individual, community, and institutional levels. This map is intended to help community leaders identify pinch points in the system and the changes needed for the greatest impact.

  Methods: The SIM map was created by using preexisting literature, mental health models, and stakeholder feedback. A participant interview guide was developed, and qualitative methods were used to conduct thematic analysis. Participants were recruited from the United Way Mental Health Initiative.

  Results: Thematic analysis revealed that major issues include addressing varying social risk factors and lack of accessibility to timely care and support. Individuals may get stuck at an intercept or not qualify for services due to social or organizational inadequacies.

  Conclusion: Although the SIM map provides a framework for the state of the mental health system in Vermont, systemic and social changes are crucial for improving the health and well-being of those with mental health needs. The Mental Health Initiative intends to use this map to help community leaders identify pinch points in the system and implement the changes that will have the greatest impact.

• 

  Professional Educators’ Perceptions of Active Shooter Drills

  Anika Advant, Connor Barton, Jackson Bressor, Caity DeCara, Akhil B. George, Briana Leger, Khadija Moussadek, and Regan Staudenraus

  Background: In 2022, 177 gunfire related incidents on school grounds were reported in the U.S., with 148 causing injuries and 57 resulting in death. Minimal data is available on the efficacy of active shooter drills, with growing concerns related to potential harmful effects on students’ mental health. The purpose of this study is to gain insight on professional educators' perceptions of preparedness, emotional consequences, and efficacy of active shooter drills in Chittenden County public schools.

  Methods: This study consists of a mixed-methods, case-study approach. A REDCap survey regarding perceptions of students’ responses to active shooter drills was sent to school districts in Chittenden County, with an optional post-survey interview. Target respondents included school administrators, educators, mental health professionals, and other support staff. Interviews were coded using qualitative analysis to identify common themes.

  Results: Out of 125 survey responses, the majority were from educators (n=79). Of these, 36% reported observing negative responses in students during a drill. Despite this, 74% believe the drills are worthwhile. Value, preparation, guidance, mental health support, and emotions after drills were identified as common themes amongst interviewees.

  Conclusion: Survey and interview results suggest that despite the negative emotions expressed by students, lack of guidance for educators, and limited mental health support, there is value in active shooter drills, and the majority felt more prepared as a result. Schools may benefit from improved communication and standardized drills. Variability within our results emphasizes the need to expand our study to other counties in Vermont.

• 

  Investigation on Eating Disorder Prevention in Vermont Public High Schools

  Adama A. Aja, Ella B. Ansell, Will P. Clark, Isabel M. Goodrich, Maisie Laud, Erzsie Nagy, Olivia R. Richardson, and Trevor Watkins

  Background: Eating disorders are a problem worldwide (1), and Vermont is no exception. A 2023 report to the Vermont legislature stated that one in ten Vermonters will develop an eating disorder and it emphasized the importance of prevention strategies (2). Our investigation sought to examine the current state of eating disorder prevention in Vermont public high schools by interviewing high school staff members.

  Methods: We analyzed CDC data and Vermont state legislative reports to identify trends in youth body perception. School staff in Northern Vermont public high schools (n=12) were interviewed to obtain qualitative insights on their schools’ prevention strategies and present barriers. A survey was also administered to other school staff (n=24) with questions regarding their schools’ policies around eating disorder prevention.

  Results: 96% of school staff agreed with the statement “disordered eating and body image is an issue for students in the school that I work.” 88% of educators agreed with the statement “I know where to go to acquire more information and resources on eating disorders.” 67% of educators disagreed with the statement “I have received training from the school to address disordered eating.”

  Conclusion: Since most educators know where to access information, compiling lists of resources regarding disordered eating may not be an effective strategy. Most participants surveyed had not received training regarding disordered eating, therefore providing training for school staff or peers should be investigated further. Future research on this topic should be focused on effective prevention strategies that can be implemented in schools.

• 

  Workplace shortage Impact on Vermont Developmental Service Organizations

  Tucker Angier; Haley N. Bayne; Julia Bernier; Jacquelyn R. Ferguson; Sarah Krumholz, RD/LDN, MS; Emmanuel Ogunlana; and Meron Yishak

  Background:

  Difficulty in maintaining workforce serving the Intellectual development disabled (IDD) population and the recruitment and training of direct support professionals (DSPs) is a barrier to care for the IDD population. A high turnover rate can put a large financial burden on these organizations and have a negative impact on the quality of life of the IDD population. Our study aimed to address the current understaffing of Vermont developmental services organizations, like Champlain Community Services (CCS) on the health of individuals with IDD and the surrounding community.

  Methods: We utilized raw data collected from CSS addressing employee satisfaction, consumer satisfaction and employee turnover. Additionally, focus groups of public health workers in the VT care partner network and CCS consumers were completed.

  Results:

  CCS data from 2016-2022 showed a higher turnover rate for employees with less tenure, appearing to indicate that employees who are new to the company may struggle with adjusting to the job. When surveyed on different dimensions of satisfaction from 2019-2022, CCS employees reported the lowest satisfaction in Work Life Balance and Pay/Benefits. These outcomes were supported in the qualitative data collected in the focus groups. Employment Support services—measured in VT population receiving Disability services— appeared to show a downward trend in all services received from 2018-2022.

  Conclusion:

  The results provide a framework for local care partners to improve their staffing crisis and the health of VT residents with developmental disabilities and suggest a focus for more standard data collection in the future to show correlative outcomes.

• 

  Assessing Demographics and Needs of Rural Community-Based Food Shelf Consumers

  Georgia A M Babb, Emma N. Fleming, Caroline R. George, Tyler J. Hastings, Timothy Hwang, Christopher Q. Lin, and Jason M. Ludlow

  Abstract

  Background: The Winooski Food Shelf (WFS) provides bi-weekly food resources to ∼700 Winooski residents, many of whom are New Americans or recent immigrants. This project aims to understand the demographic composition and healthcare needs of WFS clients and assess how WFS addresses clients’ nutritional needs.

  Methods: WFS clients 18 years or older were eligible to participate in this study. A survey, adopted from the Cornell-Radimer questionnaire for food insecurity was conducted in person on two occasions to collect demographic data of the food recipients and how well their food and healthcare needs were being met.

  Results: Fifty-two out of 133 WFS clients between 21-74 years of age agreed to participate in the survey. In this analysis we found that as visitors age, they’re more likely to report not receiving enough food from the shelf (p=0.023) . There was a correlation between increasing age and establishment of personal healthcare (p=0.034). Conversely, total household size and the number of children in the home did not correlate with how respondents answered survey questions. Additionally, respondents who primarily identified as Nepali (p<0.001) and Karenic (p<0.001) speakers were less likely to report food insecurity or lack of healthcare establishment due to financial constraints.

  Conclusion: Our findings suggest a need to address the nutritional needs of older WFS clients and to assess younger clients’ understanding of local healthcare access.

• 

  A Landscape Assessment of Family-Servicing Organizations in Vermont: Highlighting the Importance of Lived Experience in Advocacy and Policy

  Michaela Busch, Jasmine Macias, David Makaj, Kassandra Mastras, Hosna Mohabbat, Aryan S. Naik, Zoe S. Nicozisin, and Nicole W. Salib

  Background: The voices of those with lived experiences (LE) are integral in advancing health equity and eliminating disparities within maternal and child health (MCH). Current literature reports the value of engaging people with LE to inform operations that will better serve and advocate for their target populations. The goal was to assess the landscape of MCH serving organizations and pathways to engage people with lived experiences state-wide within Vermont.

  Methods: The first phase of data collection utilized an internet search targeting MCH topics as well as contribution from the Vermont Department of Health to collect qualitative and quantitative data on MCH organizations. 74 organizations were categorized based on: (1) zip codes of office locations or (2) zip codes in which they provide services. Organizations were excluded if completely federally funded. During the second phase of data collection, telephone interviews were conducted with 10 organizations that reflected a variety of populations to provide additional context to the publicly available data.

  Results: 65% of evaluated organizations had people with LE. 25% of organizations that contained people with LE provided direct services. Landscape assessment concentration of MCH serving organizations in Chittenden County, compared to rural areas, identified potential for MCH serving organizations to expand their distribution.

  Conclusion: Organizations including people with lived experiences seem to engage in more advocacy and public policy than those without LE. Both phases of data collection support the current representation in literature. Inclusion of people with LE can better inform the operations and policy development of MCH serving organizations.

• 

  Examining Vermonters’ Attitudes Towards a Sugary Beverage Excise Tax

  Avery J. Campbell, Elle G. Cunningham, Jenna G. Eaton, Christine Kahla, Ru Kambli, Mikaela J. Mari, Ian A. Strohbehn, and Alyssa B. Tenney

  Background: Americans consume more added sugars from sugar sweetened beverages (SSB) than any other food source. SSB consumption is associated with increased risk of cardiovascular diseases, dyslipidemia, diabetes, and obesity. Multiple U.S. cities have implemented SSB taxes, reducing consumption of unhealthy beverages while funding public health efforts. Our project examines Vermonters’ attitudes towards implementing a similar tax, and how use of the revenue may impact their support.

  Methods: A nineteen-question anonymous survey was distributed in person, online, and via community forums. Vermont voters ≥18 years old were included. Data were collected from 11 counties. Descriptive statistics and X² tests were performed using R. P-values were calculated with Monte Carlo simulation.

  Results: 54.6% of the 511 respondents supported the tax, 28.8% opposed it, and 16.6% were unsure. On average, those in support or unsure indicated they would be “more likely” to support the tax if revenue went towards any of the proposed public health efforts, while those opposed would be “less likely.” There was no significant difference in support between income groups. There was a significant difference in support between age groups.

  Conclusions: Over half of Vermont voters support a statewide SSB tax. The strongest support was among older Vermonters. If a tax was introduced, data suggest the level of support of those opposed would decrease if revenue went towards public health efforts and increase amongst those in support or unsure. Of the proposed public health efforts, the use of revenue towards funding school meals had the greatest average increase in support amongst all groups.

• 

  Efficacy of Mindful Art and Eating Interventions in Vermont Elementary School Children

  Matt R. Chmait, Caroline R. Duksta, Kevin Ito, Christina Kirk, Isabella R. Sutherland, Koji Welch, and Yasamin E. Zamanian

  Background: Anxiety disorders have been shown to comprise a large majority of the mental health disorders among adolescents. (Merikangas et al., 2010). In addition, the COVID-19 pandemic has had an exacerbating effect on anxiety in this population. (Wang et. al., 2022). Prior research with adolescents has shown the effectiveness of mindfulness exercises on anxiety reduction in the academic environment (Hofmann et al., 2010). Collaborating with the Milton Family Community Center in Vermont, our team developed the hypothesis that implementing mindfulness exercises into the afterschool program would reduce anxiety indicators in the classroom.

  Methods: Mindful art and eating interventions were chosen based on their effectiveness in previous studies examining similar developmental age groups. Each intervention was implemented for a two-week period, during which teacher respondents were surveyed using the Strengths and Difficulties Questionnaire at set intervals to gauge their perceptions on classroom performance. Additionally, virtual interviews were conducted and coded to obtain qualitative data and themes from teachers.

  Results: Our study found no significant changes when surveying staff members regarding classroom performance. However, all teachers reported in the interview that they believed mindfulness exercises generally benefited students and, if implemented for a longer period, they may create a more impactful change.

  Conclusion: Future studies which implement a longer intervention period and a greater sample size of teachers for reporting classroom performance are needed to further explore the use of mindfulness exercises in mitigating anxiety-related learning difficulties in students.

• 

  Literature and Medicine: Benefits of and Barriers to the Implementation of Book Clubs for Health Care Professionals

  Hayden Christensen, Molly Greenblat, Michelle Nuyen, Shrey D. Patel, Kara M. Pflaster, John L. Rustad, Julie Scholes, and Alex Tran

  Background: While traditional medical education emphasizes acquiring knowledge and technical skill, there is increasing recognition of the role humanities play in improving medical practice, interprofessional development, and patient-provider relationships. This study analyzes the benefits, drawbacks, and barriers to implementing Vermont Humanities Council’s (VHC) narrative book club, Literature and Medicine (L&M), in clinical settings to determine post-pandemic feasibility and best practices for program expansion.

  Methods: Two subject groups were interviewed: Vermont clinical institutions with and without narrative book clubs. Following interviews, the benefits, drawbacks, and barriers to implementation were coded to analyze differing perspectives from institutions with and without book clubs. These results were amalgamated into recommendations for VHC to guide its expansion of L&M.

  Results: Hospitals currently running L&M reported numerous benefits, the foremost being interprofessional development and learning new perspectives. The hospitals reported a spread of professions represented in L&M. Hospitals not currently running L&M reported interprofessional development as the major perceived benefit. Additionally, these hospitals reported an average interest of 4/5 in developing a program with VHC. However, significant barriers exist; time and staffing issues were reported as areas of concern for hospitals considering implementation.

  Conclusion: Interprofessional development and peer learning can be achieved through L&M. These results reflect the known positive outcomes cited in humanities-based medical programming. However, barriers to implementation must be addressed for successful implementation. Any novel L&M program must address the time commitments and constraints of an already overworked population.

• 

  Family-Centered Perspectives on Barriers to School Attendance

  Cassidy Cottle, Brian A. Fellenstein, Steven M. Hepp, Molly Hurd, Kristin Karpowicz, Joshua H. Le, Jasmine M. Liu, and Sarah Yang

  Background: Truancy, or chronic absenteeism, is defined as missing 10% or more of school days. Students who are chronically absent any year between 8th and 12th grade are seven times more likely to drop out. A Howard Center survey found that 33% of students in the Burlington school district were chronically absent. Schools identified the complex and intensive needs of students and families as the main driver of truancy. Our aim was to survey family perspectives on barriers to school attendance, the efficacy of attempted strategies, and family suggestions for future strategies to address truancy in Chittenden school districts.

  Methods: We designed an interview script that was used to interview families recruited by community partners. Eight coders examined interview notes using a thematic content analysis to identify areas of need for families.

  Results: We conducted a group interview of four Somali families via translator. Themes from caregivers’ responses included: 1) communication breakdown between the school and families, 2) racism as perceived systemic bias from school staff, 3) safety as a perceived lack of concern by the school for students, and 4) caregivers identified the biggest positive influence on their child’s attendance as teachers who create an inclusive and inspiring learning environment.

  Conclusion: More work is needed to learn the diverse perspectives of the Burlington community. Families may be more comfortable with group interviews conducted at established, school-sponsored events. Based on the interviews, fostering positive relationships among teachers, families, and students may prove to be most beneficial at combating chronic absenteeism.

• 

  Recruitment of Primary Care Professionals in Rural Vermont: An analysis of factors motivating resident physicians and DNP students at UVMMC

  Tanner L. Ferrell, Julia Halvorson-Phelan, Christopher Kruglik, Anton Krutyakov, Angelina Kuzina, Anna Landis, Joon Young Lee, and Kathleen Waeldner

  Background: Windham Aging was created to analyze, primarily, ways for senior residents to age in place; a November 2022 report concluded that one of the barriers is lack of primary care professionals. The current physician workforce is aging into retirement with 48% of PCPs in Windham County being over 60 years old. Previous literature reported the following themes among primary care professionals as factors in determining retention and recruitment: financial, social, lifestyle, and community.

  Methods: This research study aimed to identify strategies to enhance the recruitment of primary care professionals in rural areas of Vermont. The study team conducted interviews with family medicine residents and Doctor of Nursing Practice (DNP) students. Using a qualitative, inductive approach, the team identified key themes that could impact the recruitment of primary care professionals in rural Vermont, including a 5-point scale on previously identified factors affecting recruitment.

  Results: Trainees (n=13) ranked housing, political association, community factors, and access to schools as most important. Qualitative analysis revealed that trainees’ financial incentives weigh less heavily than previous rural clinical experience and interest in living in a rural setting.

  Conclusion: Recruitment of rural practitioners in Vermont is largely influenced by personal preferences regarding community attributes and exposure to rural clinical training experience.

• 

  Improving Access to Adult Home-Based Palliative Care Through Medicaid Expansion

  James T. Go III, Adam M. Lewis, Rachel E. Miles, Surya Radhakrishnan, Shruthi Santhanakrishnan, and Anthony M. Vejar

  Background: Palliative care is associated with a more than fifty percent reduction in costs associated with end-of-life care. Currently 30% of Vermonters receive their healthcare through Vermont’s state Medicaid program. Despite this large proportion of Medicaid recipients, there is no Medicaid-funded home-based palliative care program in the state. The objective of this project is to better understand the need for home-based palliative care and assess the barriers to these services.

  Methods: A systematic literature review was conducted to develop a palliative care service package based on the models of Arizona, California, and Hawaii. Interviews with medical professionals and a focus group with representatives from multiple Home Health Agencies (HHAs) were conducted. The interviews and focus group were recorded and transcribed. Transcripts were reviewed by two separate coders in NVivo software, and the codes reconciled to unify qualitative themes and quotes.

  Results: From qualitative data, several core themes were extracted such as: benefits to healthcare, staffing and reimbursement, and education. Overall, benefits to providers and patients and educational gaps were among the most emphasized themes. Staffing and reimbursement were the primary concerns for HHAs for whom fee-for-service models may not be sufficient.

  Conclusion: Implementation of home-based palliative care services can benefit patients and healthcare providers by reducing hospitalizations and enhancing patient care. Delivery of these services remains challenging due to a variety of factors, including financial and staffing constraints from HHAs and educational gaps within the healthcare community. Medicaid expansion may help ensure effective palliative care delivery in Vermont.

• 

  Assessing College-Age Adult Attitudes and Perceived Barriers and Facilitators to HPV Vaccination

  Arman S. Grewal, Katina Messier, Christopher Pham, Aina K. Rattu, Susanna L. Schuler, Deepinder Singh, Peter Vien, and Abigail B. Wootton

  Background: The HPV vaccine is recommended for people aged 11 to 26 and is effective at preventing against certain types of cancers. Current vaccination rates among college-aged individuals remain inadequate. This study aims to assess attitudes to HPV vaccination and elucidate differences in awareness among individuals of different vaccination status.

  Methods: Medical students and premedical undergraduate students engaged individuals in a central campus student location to collect survey responses and educate about HPV and HPV vaccination. A peer-education approach was utilized to engage students. Knowledge gaps were generally assessed via a true/false questionnaire during peer-to-peer interactions and a link to a REDCap survey was shared. Respondents completed it themselves. We used one-way ANOVA and T-tests to compare levels of awareness levels and HPV vaccination status.

  Results: 209 survey responses from UVM students qualified for analysis. A majority of students had completed an HPV vaccine series. Survey results showed respondents learned of HPV and the vaccine from a variety of sources, but primarily from family or in a clinical setting. Average awareness also varied amongst individuals with differing HPV vaccination status.

  Conclusion: There may be associations linking greater knowledge of HPV with “Completed” vaccination status. Results demonstrate that awareness may not equate to general knowledge of HPV, possibly contributing to disparities in vaccination rate. With year-to-year HPV vaccine awareness declining, there is an increased need for educational campaigns to not only raise awareness about HPV but also on HPV topics like its transmission, disease prevention, and federal guidelines.

• 

  Improving Health Communication: Testing Preferences and Choices for Health Information to Improve Literacy

  Casey Norton, Wendy Memishian, Sarah Kohl, Kyle M. Gorman, Muhammad H. Zeb, Haziq Aziz, Taylor Lamarre, and Adam B. Thompson

  Background: Health literacy and effective health communications are growing areas of concern. This project aims to determine differences in health literacy and preferred communication methods of health information between Vermont rural and urban populations.

  Methods: In-person surveys were conducted in Vermont rural and urban settings. Clinical trials were used as a baseline example of health communication to gather information on preferred methods of receiving health information, and comfort interpreting health information. Survey questions were developed using pre-established questionnaire guidelines from CDC health status surveys. Statistical analysis was performed using Microsoft Excel and GraphPad Prism 6. Chi-squared and unpaired T-tests were used for data comparison.

  Results: 272 individuals completed the initial survey with 262 meeting inclusion criteria. Of the 262 respondents, 89% white (n=233) and 54% female (n=141), 55% had a bachelor’s degree or higher (n=145); 14.5% reported having previously participated in a clinical trial (n=38). Distribution of zip codes based on Rural-Urban Commuting Area (RUCA) Codes showed individuals from rural area populations (RUCA = 10) and metropolitan area core populations (RUCA = 1). Survey results found statistical significance between rural and urban populations in comparing health communication preferences, with rural participants significantly preferring television and social media as outlets to receive health information.

  Conclusions: Both urban and rural residents most frequently selected healthcare providers as a preferred communication outlet, followed closely by the internet. Mean confidence level differences between rural and urban populations for multiple modalities of medical information were not statistically significant.

• 

  Inclusive Sexual History for Sexually and Gender Diverse Individuals in Vermont

  Krystal Ramos-Barrera, Kimberly Michelle Jones, Elizabeth Karakashian, Ian Minearo, and Ashley Lucero

  Background: Patients that identify as lesbian, gay and/or transgender (LGBTQ+) experience poorer healthcare outcomes due to discrimination, stigma, and marginalization. Interaction with a new healthcare environment is through intake forms which often use hetero-centric language around sexual history gathering. We address this by the assessment of these forms through the lens of members of the LGBTQ+ community. We aim to decrease the harm associated with current wording and improve the experience and trust of patients who identify as sexual or gender diverse.

  Methods: We used focus groups as our primary means of data collection. First, we recruited a group of participants based on our research objectives. Second, we conducted 2 focus group sessions totaling 6 participants in a private setting and took detailed notes. Third, we analyzed the data using thematic analysis and 5 people coded the data into categories. Then, we visualized the findings using quotes and summarized the main themes. Finally, we presented the survey of updated questions to guests at the LGBTQ+ Health Summit to gain feedback.

  Results: Thematic analysis of the focus group data demonstrated multiple prominent themes. These themes reflected gender and sexually exclusive word choices, phrasing that was exclusive to patients for which English is not a primary language, and lack of question clarity.

  Conclusion: Despite major advancements in the quality of care LGBT+ patients receive in the primary care setting, there are still considerable adjustments that need to be made to ensure all individuals feel respected and included while giving a sexual history.

• 

  Vermont Stakeholder Views Regarding Psychedelics in 2023

  Cole Zweber, Josephine Yalovitser, Sarah Tran, Lauren Tien, Mallory Stultz, Ava Siegel, Henry M. Mitchell, and Jonah Levine

  Background: Psychedelics, such as MDMA, LSD, ketamine, and psilocybin, are defined as mind-manifesting substances. While Indigenous communities have used psychedelics for millennia, scientific research in the United States began in the 1940s. Following a rise in recreational psychedelic use during the Counterculture Movement of the 1960s, many psychedelics were issued Schedule I status. In the past fifteen years, research on the therapeutic potential of psychedelics has emerged as a burgeoning field. The objective of this study was to assess opinions towards psychedelics in Vermont.

  Methods: Using a literature review on psilocybin, MDMA, LSD, ketamine, and ayahuasca, an interview guide was designed to explore current attitudes on the state of psychedelics, policy surrounding psychedelics, and ongoing training and treatment practices. A convenience sample of 16 healthcare providers, legislators, investors, advocates, and law enforcement officers was interviewed.

  Results: Qualitative analysis of interview transcripts indicated a need for superior pharmacologic treatment to address the growing mental health crisis and expressed cautious optimism with regards to the promise of psychedelics. Interviewees emphasized the importance of further research on efficacy and safety and expressed concerns for current models of legalized psilocybin. Counselor training and education emerged as crucial considerations for psychedelic treatment. Other barriers included cost, scalability, and equitable access.

  Conclusion: While the growing body of research on psychedelics indicates promise in addressing intractable mental health disorders, voices from all sides advise the field to exercise caution. Further research is needed to ensure equitable access, establish safe treatment procedures, and enact responsible policies.