Public Health Projects, 2008-present

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  Transforming Disability Services: A Study on Large Language Model Acceptance and Utilization Among Support Staff

  Neelia Abadi, Naomi Burhans, Margret Joos, Edward Harrington, Eryney Marrogi, Aiden Masters, Jai Narain, and Curtis Plante

  Background: Champlain Community Services (CCS) is a Vermont-based non-profit which helps adults with intellectual disabilities and autism find meaningful employment and community engagement opportunities. We sought to investigate large language models (LLMs), a form of artificial intelligence (AI), as a tool to enhance the work of Direct Support Professionals. Specifically, we aimed to assess knowledge of LLMs and routes for their implementation at CCS. Methods: Staff members (n=66) were administered a pre-training survey (responses = 39) prior to a 30-minute training session. Attendees (n=40) were given a post-training survey (responses = 25). Responses were analyzed in Python. Results: After the training, 3.3% and 14.4% more participants described themselves as “somewhat familiar” or “familiar” with AI, respectively. No participants rated themselves as “not familiar at all” with AI, compared to 15.4% of participants pre-training. Smaller percentages of participants were concerned about job displacement (percent change (PC) = -3.1%), lack of training (PC = -3.3%), and effectiveness (PC = -4.7%). An increased percentage were concerned about privacy and data security (PC = 11.9%). 19% more respondents thought AI could improve CCS’s services while 12.7% fewer people thought AI would not improve their services. Conclusion: Employees’ enhanced familiarity with AI and belief in its benefits support the utility of LLMs in services for adults with intellectual and developmental disabilities and autism after training is provided. Participants’ remaining concerns following training suggest future sessions should focus on addressing privacy-related concerns. Further inquiry should investigate applications of AI within larger organizations within and beyond Vermont.

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  PCP Attitudes: Understanding of Cancer Risk from CT Imaging

  Kenneth Allen, Caitie Beattie, Noah Manz, Max Pendleton, Chloe Ruscilli, Chloe Ruscilli, Zaymee Syeda, and Eli Zettler

  Background: The use of ionizing radiation in medical imaging has revolutionized the ability to diagnose and treat illness. While it is difficult to measure the risk associated with low-level radiation exposures, estimates can be made by extrapolating data from atomic-bomb survivors. Based on these estimates, the American College of Radiology has recommended steps that clinicians can take to minimize risk for patients.​ Studies evaluating knowledge of radiation risk have so far focused on physicians in emergency and surgical settings, finding potential gaps of significance. This study seeks to establish radiation-safety knowledge possessed by primary-care providers in the state of Vermont. Methods: A structured survey was created to assess primary-care providers' (PCPs) attitudes, practices, and knowledge about ordering CT scans and sent to PCPs within the UVMMC Health Network. Results: Survey results demonstrated a widespread lack of knowledge of CT risk. Out of a maximum score of 5 on the knowledge assessment portion, the average test performance was 2.2. Average test scores were tabulated against graduation year from medical school, self-rated familiarity and knowledge with CT imaging, and levels of training in this specific area. No comparisons reached statistical significance (p<0.05). Conclusion: Despite differences in training, familiarity with CT, and professional titles, there remains a lack of knowledge regarding CT radiation safety. Further research and advancements in CT knowledge, along with increased education for medical professionals, are necessary.

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  Understanding barriers to equitable care for people with intellectual and developmental disability

  Alexia Amaio, Dalton David, Michael Greenberg, Thomas Khodadad, Harsimran Multani, Sarah Pfreundschuh, Selin Tukel, Leena Ziane, and Thomas Griffin PhD

  Background: Approximately 14% of the U.S. population live with an intellectual and/or developmental disability (IDD). Individuals with IDD face barriers to accessing equitable healthcare, contributing to health disparities. In collaboration with Special Olympics Vermont (SOVT), this study aims to identify and understand the barriers individuals with IDD encounter when seeking healthcare. The findings will help inform strategies to improve access and promote equity. Methods: A Redcap survey including 16 multiple-choice and 2 open-ended questions was designed to understand the barriers to equitable care for individuals with IDD. Surveys were distributed via the SOVT email list and at an SOVT athletic event. Survey participants, including athletes and their parents/guardians, were offered the opportunity to share thoughts via Zoom interview or in-person interview at the athletic event. Qualitative themes were identified following review of interview notes. Descriptive statistics and Chi square analysis were conducted in R Studio Version 4.4.2. Results: Analysis of qualitative interviews yielded 5 major themes revolving around communication difficulties based on quotes from athletes/caregivers. Survey results for multiple-choice questions demonstrated room for improvement in several areas. Most notably, respondents reported overwhelming negative experiences with communication and positive experiences with access to care and provider availability. Conclusion: Despite positive responses regarding healthcare logistics, additional work is needed on provider training and ensuring patients with IDD are communicated with effectively and appropriately. Interviewees frequently remarked on feeling overlooked during appointments. Future directions include developing such training and implementing it for all medical providers.

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  Addressing Social Isolation and Loneliness Amongst Older Vermonters

  Anastasia Arvin-DiBlasio, Jonathan Chen, Oona Davies, Jonathan Palmer, Benjamin Rubin, Matthew Saunders, Zachary Wheeler, and Garrett Wu

  Background: This study sought to identify ways to address loneliness and social isolation among older Vermonters. Social isolation in the elderly is linked to increased anxiety, depression, and loneliness. Methods: We investigated the prevalence and nature of loneliness and social isolation among older Vermonters (65+). Using a mixed-methods approach, 40 participants completed a survey incorporating the Steptoe Social Isolation Index, self-identification of loneliness and social isolation (based on Merriam-Webster definitions), and open-ended questions exploring potential solutions to loneliness, effective interventions to address the loneliness epidemic, and factors promoting social connectedness. Results: Quantitatively, 10% met Steptoe criteria for social isolation, while 32.5% self-identified as socially isolated and 42.5% as lonely, highlighting a discrepancy between standardized measures and lived experience. Notably, 25% reported experiencing both loneliness and social isolation. Qualitative data were analyzed using a group coding system, identifying recurring themes within responses. Regarding loneliness mitigation, “Connection & Communication” (40%) was most frequently cited, followed by “Community Engagement & Volunteering” (30%) and “Physical Activities & Hobbies” (27.5%). Addressing the loneliness epidemic prioritized “Social Programming & Community Culture” (70%), “Infrastructure & Services” (40%), and “Public Meeting Spaces” (30%). Maintaining social connectedness emphasized “Social & Community Engagement” (40%), “Friends & Family” (37.5%), and “Mindset” (37.5%). Conclusion: These findings suggest that while standardized measures provide a baseline, self-perception of loneliness and social isolation is more prevalent. A multi-faceted approach addressing both individual needs (connection, activity) and societal structures (programming, infrastructure) is crucial for combating loneliness among older Vermonters.

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  Health Professionals' Awareness of Accommodations for Deaf/Hard of Hearing Patients at UVMMC

  Lajla Badnjević, Marina Cannon, Joselvin Galeas, Hamza Mirza, Elizabeth Pendlebury, Lauren Schiff MS, Genevieve C. Wakeman, and Oliver Young

  Background: The Vermont Deaf, Hard of Hearing, and DeafBlind (DHHDB) Advisory Council estimates that 400 to 600 Vermonters are culturally deaf, with 12 to 20 identifying as deafblind. DHH individuals are nearly seven times more likely to have inadequate health literacy, contributing to higher rates of chronic conditions and lower healthcare satisfaction due to communication barriers. This project assessed University of Vermont Medical Center (UVMMC) employees' perceptions of healthcare barriers for DHHDB patients and knowledge of accommodation services. Methods: Survey questions were developed based on literature on health access accommodations for DHHDB individuals. The survey was distributed via a poster QR code to UVMMC departments. Results: The survey received 81 responses from physicians, nurses, American Sign Language (ASL) interpreters, and front desk staff. Sixty percent reported interacting with DHHDB patients weekly, and 74% felt comfortable doing so. Over 80% were aware of clear masks, video remote interpreting (VRI), and in-person ASL interpreters. However, only 64% were aware of how to access in-person interpreters, 73% how to access VRI, and 14% how to access telehealth VRI connections. Awareness of tactile interpreters and patient portal alternatives was 5%. Additionally, 70% reported not receiving onboarding training for DHHDB services, though 86% expressed willingness to complete such training. Conclusion: The survey highlights gaps in awareness and use of DHHDB accommodations. While most respondents felt comfortable interacting with DHHDB patients, knowledge of resources was limited. Addressing these gaps through enhanced education and procedural improvements could improve healthcare delivery for this population.

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  Prevent Child Abuse Vermont Demonstrates the Long-Term Benefits of the Nurturing Parenting Programs in Improving Parents' Attitudes Toward Their Children

  Tanner Baroni, Grace Kim, Elizabeth Medve, Sung Bin Roh, Benjamin Sebuufu, Eunice Suberu, and Shannon Wasley

  Background: Over 600,000 children in the United States experienced abuse or neglect in 2021. Programs for child abuse prevention have shown reductions in child abuse; long-term follow-up research has not been performed. This project collaborated with Prevent Child Abuse Vermont (PCAVT) to examine long-term outcomes of the Nurturing Parent Program® (NPP) on patterns associated with child abuse and neglect. Methods: The NPP assesses risk using the validated Adolescent Parenting Inventory (AAPI) before and immediately after the program. The current study distributed an optional survey containing five subjective open-ended questions and AAPI to 321 former participants via two emails and a text reminder. Quantitative data was analyzed using methods from the NPP; qualitative data were coded and analyzed to identify themes and insights regarding the program's impact. Results: Thirteen responses were received; 10 completed the AAPI. Data from PCAVT showed improvement in all constructs immediately after the NPP. Post-post testing demonstrated sustained improvements above pre-test values for four constructs, while scoring on the use of corporal punishment was worse than baseline. Free response questions demonstrated themes of realistic expectations of children and learning both coping and self-regulation skills. Nine of eleven respondents wished they completed the NPP sooner. Conclusion: Our study is one of the first to evaluate long-term impact of programs like the NPP. PCAVT has highlighted the importance of long-term evaluation to support maintaining no-cost offerings to future participants. Future investigation into changed attitudes toward corporal punishment could elucidate how to sustain improvements in this area as well.

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  Understanding the Challenges and Motivations for Dentists to Practice in Rural Vermont: A Study on Recruitment and Retention in Windham County

  Kartheek Batch, Alison Chivers, Aaron Dees, Kiersten Donovan, Matthew Mullen, Estefania Obando, Harjas Sabharwal, Marty Hammond, and Carolyn Taylor-Olsen M.D.

  Background: Rural populations often experience limited access to healthcare due to a shortage of providers, financial constraints, and logistical barriers. Windham County in Southeast Vermont exemplifies these challenges, with only 50 dentists per 100,000 people compared to the national average of 60 per 100,000. The objective of this project is to identify the barriers to recruiting and retaining dentists in rural Vermont, focusing on understanding what factors motivate dentists to practice in underserved areas and what obstacles discourage them. Methods: This study incorporated a literature review, interviews with rural dentists in Windham County, and surveys of dental residents at the University of Vermont. Interviews identified challenges such as geographic isolation, financial pressures, staffing shortages, and integration difficulties within rural communities. Survey responses provided additional insights into perceptions of rural practice, highlighting both barriers and motivators for recruiting and retaining dentists in underserved areas. Results: Key barriers to rural dental practice included the high cost of dental education, low Medicaid reimbursement rates, and limited professional support networks. However, several dentists cited a strong sense of community and personal fulfillment from serving a close-knit population as positive factors that improve retention. Conclusion: Analysis of the survey responses suggests that targeted financial incentives, community integration efforts, and support networks may help attract more dental professionals to Windham County and similar rural areas.

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  Examining the Adolescent Mental Health Crisis in Vermont Through the Experiences of Healthcare Providers

  Cliff Bauman, Jeff Heithmar, Ryan Marawala, Jill Rogers, Evelyn Thomas, Alex Vitali, and Kyra Weaver

  Background: Vermont is experiencing an adolescent mental health (MH) crisis, with 34% of Vermont high schoolers reporting poor MH and 20% of middle schoolers reporting thoughts of suicide. Our aim is to assess Vermont MH providers’ perceptions and utilization of adolescent MH resources towards the goal of improved understanding of barriers and facilitators for accessing quality adolescent MH services. Methods: We developed and implemented a survey of Vermont MH providers consisting of eighteen multiple choice and five free response questions. Topics included assessing respondents’ educational background and practice setting, awareness of current resources, assessments of those resources, and priority issues for improving adolescent MH. Data analysis used a thematic content approach and descriptive statistics. Results: We received 77 responses from physicians, nurse practitioners, physician assistants, registered nurses, LICSWs, LMSWs, and MH professionals. Review of multiple choices questions points to: 1) Comfort screening adolescents for MH problems but less with treatment, 2) Similar levels of comfort in recommending and referring adolescents to MH resources, and 3) More comfort in working with families of adolescents than schools. Thematic analysis of free responses yielded themes regarding current care inadequacies: 1) lack of access to appropriate care, 2) insufficient resources for patients, 3) providers unable to navigate the current system, and 4) lack of providers. Respondents also reported gratefulness for their colleagues and statewide resources. Conclusion: Preliminary results support the need for additional MH provider capacity and training in Vermont and for addressing systemic issues impairing optimal treatment of our adolescent population.

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  Vermont Public School Preparedness for Sudden Cardiac Arrest

  Brian Canova, Isaac Sellinger, Jake Ayisi, Kelly Tran, Anthony Jeong, Mohamed Ahmed, Michael Hermanto, and Syed Jafri

  Background: Sudden cardiac arrest (SCA) survival decreases 7–10% per minute without treatment, with EMS response averaging 9 minutes. Early AED use doubles survival. Only 55% of Vermont high schools have cardiac Emergency Action Plans, prompting this study to assess and improve emergency preparedness. Methods: A confidential web-based survey assessed sudden cardiac arrest preparedness in Vermont public schools (Oct–Dec 2024) via REDCap. It examined school demographics, Emergency Action Plans, AED availability, CPR/AED training, EMS coordination, and cardiac events. IRB-exempt data collection aimed to identify barriers and evaluate cardiac emergency preparedness. Results: A survey of 159 respondents found that AED availability in schools is universal among respondents (100%). with most units publicly accessible at all hours (97.5%) and having modest maintenance costs (<$500: 70.5%). Despite this, only 52.5% of Vermont schools have plans for sudden cardiac arrest (SCA). Barriers include time constraints, insufficient support, and lack of guidance. Funding primarily comes from school budgets (60.4%) and grants (24.5%). Compliance with proposed bill provisions varied, with 35.7% meeting all four criteria for preparedness. Conclusions: Our survey reveals progress and challenges in school emergency preparedness in Vermont. The financial burden of acquiring an AED would not be an issue for the majority of public schools in Vermont. Most would need to invest time and human resources into adopting a plan and coordinating with local EMS. Pre-made materials from the American Heart Association could help schools requiring guidance to meet these requirements, addressing key gaps and improving compliance with proposed legislation.

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  Assessing Palliative Care Reimbursement Models through Vermont Medicaid

  Elliot Cullen, Petergaye Murray, Abigail Mercier, Anna Gorbacheva, Jake Reigle, and Kevin Peters

  Background: Palliative care (PC) provides a mix of comfort care and curative treatment to increase longevity while maintaining quality of life (QOL). In contrast to hospice services, few Medicaid programs reimburse for PC. The Department of Vermont Health Access (DVHA) reimburses institutional and home-based PC (HBPC) for pediatric beneficiaries, but only institutional PC for adults. The project goal is to identify provider reimbursement perspectives and models. Methods: We conducted literature reviews, and reviewed reimbursement models for palliative care coverage for California, Hawaii, and Washington. We drafted Interview scripts specific to Vermont. Thirty-minute interviews were conducted with three expert medical providers and representatives from two home healthcare providers via video conference calls. Analysis was performed through NVivo software (version 14), and common themes were identified. Results: Model, Care, Home, Reimbursement, Visit, Nurse, Palliative, Patients, and Providers were themes. Consensus was that HBPC is viewed favorably, and patients would benefit from expanded utilization. A per-member-per-unit-time, or capitated reimbursement plan was preferred due to incentivization of appropriate levels of care as well as preventative care. Challenges regarding care access were universal concerns, with lack of home-based staff and insurance coverage as the greatest concerns, along with obstacles inherent in a fee-for-service model when patients have varied needs. Conclusion: A capitated reimbursement model was noted as an option for effective and accessible HBPC services for Vermonters. A per-member-per-month (PMPM) model was proposed as the preferred reimbursement time scale to ensure that home health agencies administering HBPC are reimbursed fairly while meeting Vermonters’ healthcare needs.

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  Community-Sponsored Cannabis Education for Older Vermonters: An Investigation of Community Needs and Available Resources

  Ivan Davis, Raihan Kabir, Benjamin Koren, Maxime Lapointe-Gagner, Isabel Thomas, Merisah Trisciuzzi, Serena Verma, Andrew Warfied, Abigail Hielscher PhD, Mahat Abdullahi, Camille Bakoulis, and Amy Carmol

  Background: Cannabis use among older adults is increasing, driven in part by recreational-use legalization and evolving norms. Considering the public health impact of substance-related resources, this study investigated how community service providers are informing older adults in Vermont about cannabis. Methods: Non-medical service organizations in Chittenden County were identified in partnership with United Way of Northwest Vermont. Representatives from 58 eligible organizations were contacted. Descriptive categorical data from a seven-question, multiple-selection survey were summarized. Results: Thirteen organizations completed the survey. Forty-six percent predominantly served older adults (>50%); none offered information on cannabis. Substance-related resources were largely distributed by organizations that provided basic needs (50%) and/or community services (60%). There was overlap between organizations currently sharing substance-related materials and those interested in providing information on cannabis if made available: most sites with nicotine materials (75%) and all sites with opioid and alcohol resources indicated interest. Overall, most organizations (62%) indicated a readiness to distribute materials on cannabis education. Conclusion: Organizations serving older Vermonters lack educational resources on cannabis. However, most organizations engaged in substance education express an interest in incorporating information on cannabis. Targeted distribution of cannabis-related materials is a feasible public health solution.

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  Understanding Veterans’ Preferences for Firearm Safety Conversations: Developing Culturally Conscious Approaches to Suicide Prevention

  Joseph Du, Shannon Bennet, Taylor Krause, Jaime Rodriguez, Carlos Montejo, Amir Zafaranian, Nick Jowkar, and Sean Britton

  Background: United States military veterans suffer a disproportionately high suicide rate compared to the general population. Firearms represented the majority of lethal means involved in successful suicide attempts in veterans from 2001 to 2022. Communication with firearm owning patients is often difficult with a prevalent distrust of providers during interviews. For the provider, lack of training can lead to hesitancy approaching the topic. Once provided training, providers self-report more confidence speaking to the topic. Methods: A survey and interview guideline were designed using data from a literature search focusing on veteran suicide and firearm owning cultural competency. Data collection was performed with community partners and a convenience sample of veterans, active military, and reservists. Raw data was coded for thematic similarities and trends in themes were analyzed for formal results. Results: 11 total valid responses were obtained. Physician questioning is preferred when there are concerns on safety at home. Veterans are generally in favor of lethal means safety discussions, emphasizing the need for safe and secure storage, especially when children are present in the household. Participants preferred nonconfrontational language that emphasizes firearms being discussed in the same tone as other lethal means like medications. Participants also prefer conversations with trusted providers who have knowledge of veteran culture and of firearms safety. Conclusion: Themes are supported by existing literature on the general population. Further studies should include a larger sample and focus on elucidating cultural touchpoints that firearm owning veterans would find relatable to create and disseminate lethal means safety resources.

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  Antibiotic Stewardship in Vermont: Prescribers’ Attitudes and Perceptions

  Andries Feder; Arya Kale; Saim Ali; Francisco Cordero; Erin Manogaran; Martin Briche; Ranya Moshashaian; Sarah Chiavacci; Patsy Kelso PhD; Allison Lafferty MD; and Jan K. Carney MD, MPH

  Background: Antibiotic stewardship is essential for minimizing the adverse effects of inappropriate prescribing, including the emergence of drug-resistant pathogens and iatrogenic C. Difficile infection. In collaboration with the Vermont Department of Health, we surveyed Vermont prescribers' perceptions and attitudes towards antibiotic resistance and stewardship initiatives. Methods: We conducted a statewide survey of 82 practicing prescribers in Vermont, distributed via messaging from the Vermont Department of Health. Regression models were used to analyze statistically significant trends. Results: Respondents included physicians, nurse practitioners, dentists, and physician assistants. Most respondents (85%) agreed that antibiotic resistance was a concern for their practice. However, fewer (52.5%) agreed that inappropriate prescribing was an issue in their practice. Physicians had the highest proportion of respondents who disagreed that inappropriate antibiotic prescribing was a concern in their practice, but had the highest share agree that antibiotic resistance was a concern. Conclusion: Healthcare providers’ perception that inappropriate prescribing is not an issue in their workplace presents a challenge for implementing effective antibiotic stewardship measures. Out of all proposed interventions, most respondents (86%) indicated that instruction on how and when to de-label a penicillin allergy in the medical record would be a useful stewardship strategy. Targeted educational interventions, specialty-specific guidelines, and regional collaborations within the medical community can better improve antibiotic stewardship.

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  Evaluating Best Practices in LGBTQIA+ Healthcare: A Vermont Diversity Health Project Initiative

  Anne Lindholm, Cassandra Chin, Lindsey Gleason, Camila Salcedo, Julia Geaghan-Breiner, Marie Kim, and Sasha Bonesteel

  Background: The Vermont Diversity Health Project (VDHP) seeks to improve care for 2STLGBTQIA+ individuals by maintaining a database of affirming healthcare providers. However, the database lacks standardized criteria for provider inclusion. In partnership with the Pride Center of Vermont, we explored best practices in 2STLGBTQIA+ healthcare and assessed whether self-identified providers on the VDHP database meet these standards. Our research question asks: Do these providers deliver care aligned with established best practices for 2STLGBTQIA+ patients? Methods: We consulted experts and reviewed literature to identify best practices for 2STLGBTQIA+ healthcare. Using the World Professional Association for Transgender Health Standards of Care 8 (SOC 8) as a framework, we developed a 31-question REDCap survey to evaluate provider adherence to these standards. The survey was distributed to 240 providers listed in the VDHP database. Results: The survey received 77 responses (32% response rate). Of respondents, 64.9% identified as part of the 2STLGBTQIA+ community, 62.3% worked in mental health, and 71% practiced in private settings. Most providers (88%) reported offering gender-affirming care, while 66% used electronic health records (EHRs) that included patient pronouns. Pronoun disclosure practices varied: 36% always mentioned their pronouns to patients, while 22% rarely did. Gender-inclusive restrooms were available in 81% of clinical spaces. Conclusions: Some SOC 8 metrics are not consistently met by self-identified providers, potentially impacting patient care. Future work should include a broader range of providers and incorporate patient input. This research could inform the development of a standardized survey to guide provider selection for the VDHP database.

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  Healthcare Workforce Implications of State Reproductive Health Policies

  Varsha Pudi, Jeremiah Bates, Jonathon Woo, Kristin Reed, Ian Kent, Oliver Koch, Nicholas Khoo, and Claudia Tarrant

  Background: Since the 2022 Dobbs decision there has been an increase in self-managed medication abortions, out of state travel to obtain abortions, and heightened burden in states where abortion remains legal. Concurrently, applications to OBGYN residency programs in abortion-restricted states declined. There is a need to understand medical provider preparedness and willingness to manage complications of self-managed abortions, and to examine the potential impacts to healthcare workforce development. Methods: Surveys were developed for practicing health professionals and trainees, with input from representatives of the target audiences. Surveys were distributed to Vermont Primary Care Providers (PCPs), including MDs, APRNs, and PAs, as well as medical trainees (UVM medical students and residents). Data were analyzed using Stata analytical software and Excel. Results: We explored generational differences in attitudes regarding reproductive healthcare. Younger generations reported greater familiarity with potential complications following a medication abortion, stronger interest in learning more about these complications, and a greater willingness to expand their scope of practice to ensure safe access to care while PCPs born between 1945-1964 (Baby Boomers) reported less familiarity and interest. Respondents reported that state-based reproductive policies influence their decisions regarding where they would practice. Conclusion: These data highlight the influence of reproductive healthcare policy on the career decisions of current and future healthcare providers, and underscore the impacts on provider scope of practice, training priorities, and career decisions across generations. Adapting PCP training and continuing education to respond to emerging legislation will be required to ensure access to safe reproductive healthcare.

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  Barriers and Facilitators to Improving Free Menstrual Product Distribution in Vermont Schools Post-Legislation

  Rhea Puthumana, Claire Baptiste, Nicki Nikkhoy, Julia Hurley, Mikayla Howie, Kimberly Bau, Sulekha Kilas, and Nancy Kaplan MS

  Background: Lack of menstrual product access forces female students, particularly trans and non-binary students, to face social and emotional distress, possibly resulting in educational gaps. Vermont’s recent legislature (Title 16: Education Chapter 031) designated menstrual products to be accessible in both women's and gender-neutral bathrooms at no cost; schools are responsible for cost, and school nurses primarily handle implementation. Methods: We conducted a literature review and interviewed two Vermont school staff members involved in implementation. We then surveyed Vermont school nurses to assess their experiences with implementing period product access in compliance with the legislation. Frequencies and chi-squared tests were used to analyze the data. Results: Among 89 school nurses (93% female, 64% aged 40-59), 66% were aware of the original Vermont legislation, primarily through the Vermont State School Nurses Association (58%). Awareness of the initial Vermont legislation is significantly associated with the presence of products in any bathrooms (p<0.01). Of those aware, 66% also knew of the legislative update mandating products in gender-neutral bathrooms, with a strong association between awareness and availability in these spaces (p<0.001). Facilitators for providing products include school budget (62%), staff support (56%), classroom discussions (49%), and working with facilities (45%). Barriers include lack of funding (41%) with some nurses relying on community donations (23%) or purchases out of pocket (17%) to sustain access. Product misuse (21%) and improper disposal (7%) were also noted as areas of concern. Conclusion: Legislation implementation has been hindered by awareness and funding. Additional efforts to raise awareness are recommended.

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  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.

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  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.

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  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.

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  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.

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  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.

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  Workplace Shortage Impact on Vermont Developmental Service Organizations

  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.

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  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.

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  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.

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  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.