Public Health Projects, 2008-present

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  The Halo Effect: Does In-Hospital Art Intervention Result in Improved Overall Patient Satisfaction?

  Brian Gross, Olivia Harrison, Olivia Larkin, Collin Love, Sean Meagher, Alice Peng, Stephanie Udawatta, Karen Lounsbury, and Rebecca Schwarz

  Introduction

  The positive impact of art therapy on medical patients has been well established in the literature.

  • Association between visual art creation and maintenance / reconstruction of a positive identify throughout cancer treatment

  • Decreased need for narcotic medications and patient length of stay following participation in guided imagery sessions

  Despite an abundance of research on art therapy, few studies have examined impact of in-hospital art intervention on overall patient satisfaction.

  Objectives

  • Examine impact of Art from the Heart (AFTH), an in-hospital art intervention program, on patient interpretation of overall care received during hospital stay—the ‘halo effect’.

  • Assess temporal, institution-level patient satisfaction survey scores following establishment of AFH intervention program

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  Engagement and Disengagement in Art Interventions with Memory Impairment

  Nana Agyepong, Karamatullah Danyal, Lauren Gaffaney, Nicole Jedrqynski, Michael Rodriguez, Matthew Sommers, Andrew Wick, Judith Christensen, and Ellen Meagher

  Introduction. Studies have shown art intervention to be an effective therapy for patients with memory impairments, leading to overall positive behaviors, increased quality of life and decreased caregiver burden. We conducted a preliminary study to evaluate and compare the effect of participation in weekly art appreciation and painting sessions on the behavior of memory impaired residents in an assisted living facility.

  Methods. Residents’ behaviors were observed during art appreciation and active painting sessions over a six-week period. Each session consisted of either viewing and discussing artwork or actively painting in the style of the artist discussed. Positive and negative behaviors were recorded and tallied throughout the sessions. Over the course of 12 sessions, the 7 observers made a total of 1957 observations of a variable patient population. The total number of both positive and negative behaviors was compared between activities, over time within sessions, as well as over the six weeks. Each session was percent normalized to the time interval with the highest occurrence of select behaviors.

  Results. Upward trends for positive and negative behaviors were noticed in ap- preciation and painting sessions respectively. The negative to positive engagements ratios for each painting session showed an increase in negative behaviors. Disengagement increased as the appreciation sessions progressed and decreased as painting sessions progressed. Overall, positive engagement increased in both appreciation and painting sessions.

  Conclusions. Despite several confounding variables encountered in this study, we demonstrated art appreciation and active painting to be a viable non- pharmacological therapeutic approach for individuals with memory impairments.

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  Impact of Deferral for Low Hemoglobin on Donor Return

  Ashley Aiken, Alexander Disciullo, Cyrus Jalai, Nektarios Konstantinopoulos, Tyler Oe, Mark Fung, Jan Carney, and Jenny Lamping

  Introduction. A consistent blood supply to support life-saving transfusions relies on regular and repeat volunteer blood donations. In this study, we focused on donors previously deferred for low-hemoglobin (Hb) levels to better understand the value of supplying post-deferral educational information, and the actions donors took based on their deferral.

  Methods. An anonymous national survey of active and inactive donor groups (10,000 each) was conducted. The survey questions assessed post-deferral donor actions, preferences regarding post deferral education, understanding of their deferral, and demographic information. Chi-square analysis was performed to compare categorical survey results between donor groups with p < 0.05 denoting statistical significance.

  Results. The survey resulted in 722 and 103 active and inactive donor respons- es, respectively. Active donors were more likely to recall receiving educational materials post-deferral (52% vs. 35%, p=003), take iron and vitamin supplements (54% vs. 39%, p=0.009), lived within 30 min of a donor site (94% vs. 84%, p=0.006), and more likely to be older than 45 yr (62% vs. 42%, p=0.002) than their inactive donor counter- parts. Active and inactive donors were similar (p>0.05) with anemia history frequency, female-gender predominance, low-prevalence of vegans, and mixed interest in receiving information about raising hemoglobin levels.

  Conclusion. While active donors more frequently recalled receiving educational materials for their low hemoglobin deferral, and were more likely to take action to improve their hemoglobin, an alternative method of post-deferral recruitment should be considered given the uncertain value of post-deferral information when comparing active vs. inactive donors.

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  Role of the Dental Community in HPV Vaccination Promotion

  Thomas Luke Arnell, Maeve Donnelly, Alexis Nadeau, Laura Till, Collin York, Pedram Zargari, Alan Howard, Wendy Davis, and Christine Finley

  Introduction. With increasing awareness that human papillomavirus (HPV) can cause oropharyngeal cancer (OPC), dental providers may play an important role in promoting HPV vaccination and preventing cancer. Our goal was to assess knowledge and current HPV vaccine counseling practices among Vermont dentists and dental hygienists to identify potential targets for state-level interventions to increase vaccine coverage.

  Methods. We developed a survey to assess knowledge, beliefs, practices and barriers regarding HPV vaccination, and distributed it via email to practicing Vermont dentists and dental hygienists. Free responses were analyzed using a coding framework generated from three key informant interviews.

  Results. 90% of providers believe it is important for them to play an “active role” in their patients’ general medical care, yet only 50% believe it is their responsibility to recommend HPV vaccine. Only 50% feel knowledgeable enough to recommend the vaccine. 78.6% of providers rarely discuss HPV vaccination with their age-appropriate patients, and 82% rarely recommend the vaccine. When asked to name the biggest barrier against recommending vaccination, providers named the following factors most frequently: “not responsibility of dental provider” (27%); lack of confidence in knowledge (19%); time constraints (14%); and parent philosophical/religious opposition (11%).

  Discussion. Because dentists and dental hygienists care for a broad pediatric population across the state, dental communities may be poised to play an expanded role in Vermont’s efforts to improve its HPV vaccination coverage. Our study identifies several potential areas for provider-focused interventions, which include educating providers about the HPV vaccine and reducing significant barriers against recommending.

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  Health and Housing Trends of Single Homeless Adults in Chittenden County, Vermont

  Alexa Arvidson, Harshal Athalye, Pamela Derickson, Gregory Johnston, Elizabeth McLeod, Elizabeth O'Neill, Andrew Pham, Christopher Brzovic, and Virginia Hood

  Introduction. Homeless individuals are at an increased risk for both physical and mental health comorbidities compared to those with stable housing. Prior studies have demonstrated that many of these individuals do not seek or receive proper medical care. This study provides a landscape analysis of health characteristics in the single adult homeless population in Chittenden County, Vermont.

  Methods. Interviews were conducted using a modified version of the Vulnerability Index – Service Prioritization Decision Assistance Tool to determine vulnerability indices across a range of different health and social wellness domains. Single home- less adults were sampled from community self-help clinics and transitional living and homeless shelters from September to November 2017.

  Results. 56 in-person surveys were conducted. Mean age of participants was 45.3 years and over half were male (63%). Extended periods or multiple episodes of homelessness were experienced most by those who reported sleeping outdoors (89%); this group also reported the highest use of emergency services (47%). The highest incidence of abuse/trauma as a contributing factor for homelessness was reported most in the 18-30 age group (71%) and least in the above 51 age group (35%). Nearly all participants owned a cell phone (86%).

  Conclusions. Single homeless adults self-reported a variety of health and social is- sues, including substance abuse, increased emergency department use, and in- creased abuse, trauma, and deteriorated social relationships. This study highlights different risk factors that contribute to homelessness in this select population. Future research should evaluate how to individually address these vulnerabilities to optimize health care and well-being.

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  Farm to Early Care and Education in Vermont

  Ramin Badiyan, Nicole Becher, Nicholas Bompastore, Stephen Daniels, Katherine Price, James Rohwer, Heather Link, and Cynthia Greene

  Introduction. Farm to Early Care and Education (ECE) is a program of the Nation- al Farm to School Network that aims to extend the core elements of Farm to School into ECE settings with the goal of improving the health of children ages zero to five and enhancing their educational experience with food and nutrition. The purpose of this project was to gather baseline Farm to ECE data for Vermont.

  Methods. The 2015 National Survey of Early Care and Education Provider was used to create a 23-question survey. The survey was built with SurveyMonkey and distribut- ed through the Child Development Division.

  Results. 600 providers received the survey with 73 respondents. Minimum one meal is served daily at 93% of programs surveyed, and most serve local foods (84%). Most food is purchased from grocery stores (97%), followed by wholesale provid- ers (64%) and farmers markets (43%). Cost and food quality were the most important factors when determining where to buy food. 80% respondents reported they don’t currently engage in Farm to ECE activities; however, when polled on activities at their center 96% of participants who originally answered no, marked at least one activity that qualifies as a Farm to ECE event.

  Discussion/Recommendations. Vermont would like to extend the Farm to School Program to 75% of Vermont schools by 2025. Based on the results of this project, we suggest that a similar goal be established for Vermont-based early care programs targeting improved nutrition for Vermont’s youngest children and while supporting local farms and markets.

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  Barriers Encountered by Syringe Exchange Clients in Vermont

  Ava Bakhtyari, Jennifer Boccia, Pooja Desai, Zachary Ehret, Jacob Lehman, Benjamin Lin, Caroline Vines, Peter Jacobsen, and Jerry Larrabee

  Introduction and Aims. Vermont CARES is a nonprofit HIV prevention and advocacy organization which provides a needle exchange program for intravenous drug users. Services are focused on education, prevention, testing, and harm reduction. The Syringe Support Program (SSP) offers clients clean syringes to reduce intravenous transmission of disease.

  Although SSP are proven avenues for harm reduction, barriers prevent users from utilizing services. Clients are limited by social, economic, and personal obstacles de- scribed in similar populations across the country. This project seeks to identify the barriers Vermont CARES clients face in accessing the SSP, determine needs, and evaluate interest in additional services.

  Methods. Our team and Vermont CARES staff held a focus group with St. Johnsbury clients to discuss services and barriers. A 39 question paper survey was distributed to three Vermont CARES sites during October, 2017 by Vermont CARES. Participation was voluntary and uncompensated. Sixty-three clients completed the survey.

  Results and Discussion. Of the 63 respondents, 61.9% stated that lack of ade- quate income contributed most to their inability to meet basic needs. These same clients faced the most barriers to access with economic hardship precipitated by sub- stance abuse, disability, and family commitments. In assessing additional services, clients sought food pantries, hygiene kits, and dental clinics. 56.4% of respondents would use safe injection facilities if provided. Those without income to meet basic needs expressed most interest in safe injection facilities (p=0.022). With barriers recognized, our future aim is to track efficacy of new services in impacting care and quality of life.

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  Supporting Vermont Families in Packing Healthy Lunches for Children in Childcare

  Nathan Benner, Isabella Kratzer, Arjun Patel, Purvi Shah, Kinjal Thakor, Alejandra Vivas Carbo, and Alison Howe

  Introduction. Partnering with Hunger Free Vermont, an organization that works to end hunger and malnutrition across the state, we investigated the nutritional value of the packed meals parents provide for their children in early childcare. The USDA's "My Plate" resource was used as a measure to assess variety, dividing foods into five groups: grains, dairy, vegetables, fruits, and protein. The results will help Hunger Free Vermont design nutrition education materials for childcare centers to provide to the families they serve.

  Methods. Online surveys were distributed, asking parents to report the foods they recently provided for their children in packed lunches, to rate how 'healthy' they thought those lunches were, and to note any barriers they experience to packing healthy foods.

  Results. Survey results showed that the average number of sweets packed by parents who had low confidence in their ability to pack healthy meals was significantly higher than the average number packed by parents with high confidence (p < 0.05). Additionally, the total number of cited barriers was significantly higher in parents who had low confidence in their ability to pack healthy meals (p < 0.01).

  Conclusions. Many parents cited time constraints and ‘picky’ children as barriers to providing healthy meals, with concerns about the expense of healthy items and lack of childcare for shopping or food-prep time following close behind. In the future, education materials that address children’s unhealthy food preferences or further investigations into barriers to providing healthy lunches may facilitate development of resources for Vermont families.

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  Health and Nutrition in Vermont Children

  Gesca Borchardt, Kyna Donohue, Anthony Gallegos, Wilson Huang, Hannah Johnson, Samuel Logan, Patrick Saunders, Paula Tracy, and Tina Zuk

  Introduction. The AHA (American Heart Association) supports legislation in Ver- mont ensuring that restaurants’ children’s menu meals meet certain nutritional standards. This study investigated Vermont parents’ attitudes towards both dining at restaurants with their children and potential legislation to improve nutritional standards of restaurant food.

  Methods. An anonymous 21-question survey for parents with children under age 18 was distributed electronically to local organizations via Facebook groups and email, and as paper questionnaires at the Community Health Center of Burlington. Questions probed parents’ overall attitudes surrounding their children’s health, habits pertaining to eating at restaurants, and attitudes towards legislation to ensure healthier options for kids at restaurants. Results were analyzed to look for dominant themes and determine differences between subgroups.

  Results. 98% of survey participants agreed or strongly agreed that their children’s eating habits are important to them. When asked if they would support legislation to set nutrition standards on children’s menu meals in Vermont, 73% agreed or strongly agreed. Most survey participants eat at a restaurant once per week or less (95%). 53% of survey participants agreed or strongly agreed that there were enough restaurants with healthy kids’ meals in their area. Responses did not differ by county.

  Conclusion. Vermont parents are concerned about their children’s diets and acknowledge connections between nutrition, obesity, and overall health. Parents favor restaurants providing more nutritional items on children’s menus and support the AHA’s proposed standards. Next steps include investigating any financial impact on restaurants and studying nutritional standards in school cafeterias in Vermont.

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  The 2017 Vermont Opioid Prescribing Rules: Prescriber Attitudes

  Zana Bowden, Jinal Gandhi, Sarah Natasha Jost, Hanna Mathers, Chad Serels, Daniel Wigmore, Timothy Wong, Jan Carney, Charles Maclean, and Elizabeth Cote

  Introduction. In July of 2017, Vermont enacted new rules on acute opioid pre- scribing to reduce misuse, addiction, and overdose associated with prescription opioids. The new rules include requirements of non-opioid therapy use when possible, querying VPMS, patient education and informed consent, and co-prescription of naloxone. Our study objective was to gain insight into the perspectives of opioid prescribers on the new rules.

  Methods. The 17-item survey included closed and open-ended questions addressing prescriber perceptions about the new rules as well as demographic information about respondents. The survey was sent to Vermont-based opioid prescribers via email, to multiple healthcare organizations and professional societies, and through personal contacts. Open-ended responses were categorized using paired reviewers and group consensus, using a grounded theory approach.

  Results. A total of 431 responses were obtained, with MD/DOs accounting for 65%, APRNs- 14%, DDS/DMD- 7%, PAs-13%, and NDs- 1%. Of the respondents, 75% thought that more restrictive opioid prescribing rules were necessary, 74% felt the new rules would have some positive effect on the opioid crisis, but only 48% were in favor of the new rules. Barriers to implementation included co-prescribing naloxone (50% were unsuccessful), justifying exceptions to rules in medical record (46% unsuc- cessful), considering non-pharmacologic therapies (39% unsuccessful), and adhering to prescription limits (31% unsuccessful).

  Conclusions. Roll-out of the new rules has been criticized for implementation issues, overall reducing favorability among prescribers. Feedback obtained may be utilized by the Vermont Health Department and by other states to improve current models of opioid prescribing.

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  Health Professionals and Public Awareness of Carbon Monoxide Poisoning in Vermont

  C. Wesley Cubberley, Julia Hannigan, Lee Hiromoto, Michael Carlo Nilo, Conner Soderquist, Eleanor Stedman, Tom Delaney, Razelle Hoffman-Contois, Jan Carney, and William Irwin

  Introduction. Carbon monoxide (CO) is the second leading cause of non-medical poisoning death in the United States. Between 1999 and 2012, Vermont saw the highest rates of CO poisoning deaths in New England. Public education and the use of CO alarms have been identified as important prevention strategies. We developed and distributed a survey to assess public and health professional knowledge of CO.

  Methods. A 21-question survey was designed, based on the validated Chicago Lead Knowledge Test, to assess knowledge about sources of CO exposure and symptoms and treatment of poisoning. Fifteen additional questions collected occupational and demographic information and preferred sources of educational information. Surveys were distributed over two months to the public, healthcare professionals, and emergency responders within Chittenden County, as well as physicians throughout Vermont. Survey responses were analyzed using SPSS.

  Results. There were 256 respondents. Healthcare professionals performed better than public respondents overall (public: mean correct=15.69, SD= 2.83, N=104; healthcare provider and emergency responder: mean correct= 17.5, SD= 2.23, N= 152). The survey questions which were most frequently answered incorrectly related to treatment and sources of exposure, as well as the similarity of CO poisoning to symptoms of influenza. Respondents preferred to receive information from printed and internet sources.

  Discussion. Medical professionals are more knowledgeable about carbon mon- oxide than the general public. Public education should include printed and online for- mats, focusing on important sources of exposure (particularly ice rinks), seeking treatment following symptoms, and similarity to flu symptoms.

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  Patient Perspectives of the Doctor-at-Home Service

  Daniel De Los Santos, Erin Hunt, Scott Mitchell, Rachel Munoz, Monica Rodgers, Gregory Roy, Danielle Smith, Jolie Lavigne, Karen Lounsbury, Jan Carney, and Karen Sokol

  Introduction. Home health care has been established as an effective model for reducing mortality in the elderly. The Doctor-at-Home Service at the Community Health Centers of Burlington (CHCB) has offered home health care to Burlington residents since January 2015. Dr. Karen Sokol, MD, alone provides care to 176 patients at their homes, including at-home palliative care. CHCB hope to expand this program by hiring more providers.

  Objective. To understand the impact of the Doctor-at-Home Service from the pa- tients’ perspective.

  Methods. A survey was administered to a cohort of eighteen patients over an 8- week period and addressed topics such as barriers to healthcare, benefits, and costs associated with doctor-at-home programs. A theme analysis on the responses was then conducted to reflect patient opinions. Available summary data describing the pa- tient population was also analyzed.

  Results. The Doctor- at- Home program serves patients ranging from 26 to 100 years old, with the majority of the patient population comprised of senior citizens. Prior to at home care, patients faced barriers such as lack of transportation, negative past experi- ences, anxiety, and distance from relatives. Four main themes from patient responses were physician-patient relationship, convenience, quality of care, and environment of care.

  Discussion. Evidence is compelling that there is a desire and need for an exten- sion of the Doctor-at-Home program to reach additional patients. Doctor-at-Home pro- grams could eliminate identified barriers and provide quality care to patients, especially those with specific barriers to access.

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  Nutrition Knowledge Assessment of Lund Family Center Residents

  Nathan Dreyfus, Caleb Knight, Jennifer Morris, Kathryn Patton, Melissa Romero, Jackie Tsao, Christopher Veal, Sarah McCarthy, and Jessilyn Dolan

  Introduction. Staff at the Lund Family Center report that there may be knowledge deficits, with regards to nutrition, among the Center’s residents—primarily pregnant/ parenting women with substance abuse and mental health issues. Before considering intervention options, we wanted to identify the specifics of the residents’ knowledge gaps.

  Methods. We administered paper versions of a revised General Nutrition Knowledge Questionnaire (GNKQ-R) Section 2 to 21 Lund residents to explore nutri- tion knowledge as compared to groups more representative of the general population. The GNKQ-R Section 2 is an externally validated, efficacious tool that specifically as- sesses knowledge of food groups and nutrients. Demographic data and free-response personal assessments of health were also collected.

  Results. The study population scored significantly lower than a UK population (p=0.002) previously analyzed using the questionnaire, however, the Lund residents scored significantly higher than a CA population (p=0.0001). There were statistically insignificant positive relationships between age, education level, and self-reported health status, in addition to slightly lower performances among those with “Single” relationship status.

  Conclusions. Though demonstrated by a small, homogenous population, the statistically significant nutrition knowledge deficit of the Lund Family Center residents, relative to the referenced UK study, warranted intervention. A brief nutrition curriculum composed of 16 focused modules was developed for future administration. The modules were oriented towards family nutrition, with content including such topics as breastfeeding advice, including children in meal-making, and macronutrient basics. These modules will be delivered to Lund residents in 2018.

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  Needs Assessment of Suicide Prevention in Vermont Middle and High Schools

  William Earle, Eli Goldberg, Mary Griffin, Amanda Kardys, Nikolas Moring, Elias Schoen, Emily Vayda, Jill Jemison, Rajan Chawla, and Kristin Fontaine

  Introduction. Adolescent suicide is epidemic. 17% of high school students con- sidered suicide and 8% attempting to take their lives in 2015 nationwide. Vermont has seen a 2% increase within the last two years according to the VT Youth Risk Behavior Survey. School is one of several settings where effective suicide interventions could take place. Previous studies have identified means prevention as an effective way to combat adolescent suicide. This study aims to identify training levels and comfort of school staff in dealing with suicidality.

  Methods. A survey was emailed to all schools in Vermont covering grades 6-12. The survey addressed employee demographics, training, perception of suicide in their school, and concern regarding lethal means. Questions were multiple choice, scaled and free responses. Data was analyzed using SPSS and free responses were organized using thematic content analysis.

  Results. 126 responses represented 46% of Vermont middle and high schools. 77% agreed or strongly agreed that they felt confident in recognizing a student with suicidality. Respondents were not comfortable implementing lethal means prevention. Respondents identified early intervention and trusting communicative relationships as key to prevention, and identified lack of time, protocols, and resources as obstacles.

  Discussion. Respondents identified suicidality in 2.2% of their students, com- pared to the YRBS that recognized 12% of adolescents. Survey technique may con- tribute to this discrepancy, but it is also likely that schools are failing to identify students at risk. A lack of comfort recognizing suicidality and implementing prevention techniques warrants standardized training, screening and response protocols.

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  Eliminating Barriers: Connecting Seniors to Services in Chittenden County

  Benjamin Flinn, Anna Lidofsky, Charles Nicoli, Eva Petrow, Zachary Silberman, Laura Thompson-Martin, Stephen Everse, and Ryan Torres

  Introduction. Physical activity programs for older adults help to improve physical, social, and emotional health and reduce impairments in activities of daily living1. In Chittenden county, less than 1⁄3 of older adults participate in programs, while 48% report that they would like to exercise more. Our aim was to identify barriers to participation in physical activity programs by older adults in Chittenden county, such as accessibility, transportation, health, affordability, and social isolation, and to identify strategies to overcome these barriers.

  Methods. 144 paper and electronic surveys were administered in Chittenden County, Vermont to assess use of group programs among older adults aged ≥ 50 years including transportation, motivation, preferences, advertisement, and barriers to access. A focus group explored aspects of ideal group activities for seniors.

  Results. 87.9% of respondents were active for two or more hours each week, while 46.5% had participated in group programming in the past 6 months. Group par- ticipation was significantly higher among physically active respondents (p=0.020). Motivators for participation in group activity included health benefits, social aspects, and physical activity, while the most cited barrier to attendance was timing conflicts. Respondents received information about programming via word of mouth, email, and online resources.

  Discussion. Overall, our findings indicate that the majority of respondents are highly active, however, they frequently experience barriers that prevent them from participating in group programming. We recommend offering flexible scheduling, advertising programming via word of mouth and email, and emphasizing program health benefits.

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  Assessing Barriers to Health Care Access for New Americans

  Dylon Gookin, Megan Kawasaki, Isabelle Mason, Cole Shapiro, Patricia Wang, Caleb Watkins, Molly Moore, and Taylor Puckhaber

  Introduction. Healthcare within the United States has been at the forefront of public discussion and political representation in recent years, particularly as it relates to healthcare access and barriers to said access. Focus has been placed on low-income groups that most generally represent the face of the average American, but this leaves the question: How are new Americans faring, and do their struggles match those faced by the rest of the country? The new Americans of Burlington, Vermont serve as a small window into a unique refugee population’s experiences with healthcare in the United States.

  Methods. A focus group consisting of 8 women was hosted on-site at the Burlington Housing Authority Franklin Square apartments. Questions were designed to determine demographic data as well facilitate subjective discussion on participants’ healthcare experiences. Translation services were provided by the resident manager.

  Results. Languages spoken were Mai Mai, Swahili, and English. Five major themes for healthcare access barriers were identified: language barriers, having children, transportation barriers, financial barriers, and a lack of preventative care. Sub- themes were also identified, which formed a taxonomy of barriers to healthcare access among the representative population.

  Discussion/Conclusions. The difficulties faced by new Americans are numerous and interrelated, leading to a perpetual cycle of insufficient healthcare. Throughout the discussion, the financial burden of healthcare was regularly raised as one of the most prominent issues faced. This concern matches with those found in similar, previous studies, that have analyzed the difficulties faced by the rest of America.

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  Radon, From the Ground into Our Schools: Parent/Guardian Awareness of Radon Levels in Vermont Schools

  Kathryn Grenoble, Florence Lambert-Fliszar, Kirsten Martin, Scott Neary, Kyle Remy, Shawn Sanford, Ethan Witt, Rebecca Ryan, David Kaminsky, and Jan Carney

  Introduction. Radon is the leading cause of lung cancer among non-smokers. Ex- posure to radon in schools may be harmful to schoolchildren, faculty, and staff, but there is currently no legislation mandating testing or mitigation of radon levels in Vermont schools.

  Objectives. The goal of our study was to assess Vermont parents’ awareness of radon’s harmful effects, as well as awareness of and support for testing and mitigation of radon levels in their children’s schools.

  Methods. We distributed paper and online surveys to Vermont parents of children grades K-12. 126 surveys were received and quantitatively analyzed. We held a focus group of two Vermont parents to gather qualitative data.

  Results. Most surveyed parents demonstrated general knowledge of radon, but only 51% believed that radon affects the lungs. 8% were confident that their children’s schools had informed them about radon levels. 91.2% believe their children’s schools should take action to address elevated radon levels and 87% would support mandated mitigation. There is some concern and lack of knowledge about the financial implications of radon mitigation.

  Conclusions. Most Vermont parents of children grades K-12 are unaware that radon is a lung carcinogen and do not know their children’s school’s radon levels or mitigation status. However, most are in favor of legislation that would require testing and dis- closure of schools’ high radon levels. Educating parents about school radon levels and their association with lung cancer could be a foundation for community support of legislation that mandates testing and mitigation of radon in Vermont schools.

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  Transportation Barriers to Healthcare in Adults 65+ in the Greater Burlington Area

  Britta Kilgus, Michael Persaud, Nicholas Selig, Harris Syed, Vanessa Trieu, Danielle Wall, Wendy Hou, Yiping Hou, Leah Soderquist, and Jeanne Hutchins

  Introduction. Missed appointments often lead to poorer health care outcomes for patients and pose a major economic burden on medical centers. Transportation is an obstacle to accessing medical care for elderly patients in Vermont and results in delayed medical appointments.

  Methods. We surveyed senior citizens in Chittenden county to determine both the type of transportation barriers and medical care missed due to the lack of transpor- tation. An original survey assessing the impact of transportation to health care was distributed in person and through an online platform. Participants were asked to identify the following in the past year: how often transportation was an issue for healthcare, specific barriers to transportation, and which specific health care appointments were missed due to lack of transportation. Ninety-six surveys out of a total of 251 collected were included in the analysis. Respondents were grouped into either having high transportation barriers, n=43, (always, often, sometimes had issues in the past year), or low transportation barriers, n=53, (rarely had issues).

  Results. The high barriers group reported more missed appointments, with eye appointments being the most frequent, and depended more on other modes of trans- portation. The low barriers group was able to drive themselves to their appointments more often.

  Conclusion. The results suggest a trend between barriers to transportation and a lack of access to healthcare appointments. Although more than half of the survey respondents indicated that they do not currently experience transportation barriers, many expressed concern about the transportation difficulties they could encounter in the future.

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  Patient Perspectives on Medication Assisted Therapy in Vermont

  Ashley D. Adkins, Holly Bachilas, Florence DiBiase, Michael J. Marallo, John Paul Nsubuga, Lloyd Patashnick, Curran Uppaluri, Elizabeth Cote, and Charles MacLean

  Introduction. Medication-Assisted Therapy (MAT) for opioid addiction has dramatically increased in Vermont, supported by a novel statewide system that integrates specialty treatment centers ("Hubs") with primary care office-based opioid therapy ("Spokes"). In 2010, Vermont had the highest per capita buprenorphine use in the US. Previous studies of patient perspectives of MAT have identified social barriers, rigid program rules, and concerns about withdrawal and relapse as common causes of treatment failure. Our goal was to elicit patient perspectives on barriers and enablers of successful MAT to further inform system refinement.

  Methods. An interview guide was developed based on previous literature as well as discussions with program leadership, staff and clinicians, and community stakeholders. Responses were organized using thematic content analysis with consensus across seven interviewers and two analysts. The interviews were conducted with 44 patients enrolled in MAT at two Hub sites in Burlington, VT in October 2016.

  Results. The median age of subjects was 34 years, 34% were employed at least part-time, and 72% were female. Half reported a mental health condition and 20% reported chronic pain. Barriers included transportation (25%), lack of stable housing, and stigma (41%). Enablers included feeling supported (82% felt well-supported; 52% felt supported by healthcare professionals). Subjects expressed high confidence in the treatment system and high self-efficacy for sobriety.

  Conclusions. Patients in MAT have complex medical, mental health, social, personal, and work lives. A comprehensive system that addresses this wide range of domains is critical to achieving optimal outcomes.

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  Gaps in Adolescent Tobacco Prevention and Counseling in Vermont

  Dexter C. Allen, Morgan Hadley, Margaret Klepack, Amber J. Meservey, Lynn Sipsey, Greg Whitcher, Mushtaba Yuridullah, Jill Sudhoff-Guerin, Jill Jemison, and Jan Carney

  Introduction. Tobacco use remains the leading cause of preventable death in Vermont. While the Vermont Blueprint for Health includes compensation for adult tobacco counseling, it includes no specific mention of pediatric populations. Research questions: To what extent are tobacco assessment and cessation efforts occurring in the primary care setting with pediatric patients? What factors influence their practices?
  
  Methods. A 12-question electronic survey, modeled on an American Academy of Pediatrics survey, was distributed to primary care providers throughout Vermont; through the UVM departments of pediatrics, family medicine, the Vermont Medical Society and the Vermont Area Health Education Center. We received 70 completed surveys.
  
  Results. 70% of the surveyed primary care providers begin tobacco counseling at the age recommended (11 years) by the Vermont Department of Health. Only 45.71% of providers are confident in their understanding of the recommendations for adolescent health screening written in the Blueprint for Health. Additionally, only 67.1% of the providers expressed confidence in their ability to provide guidance regarding the harmful effects of E-cigarettes, compared to 92.8% feeling confident regarding conventional cigarettes. 70% of providers listed time restraints as a significant factor in their decision not to counsel adolescents on tobacco use.
  
  Discussion. The Blueprint for Health is a guiding document for provider practices that is not well understood and does not specifically include pediatric tobacco prevention. In an environment where youth E-cigarette use is rising, especially among adolescents, it is especially critical that physicians are confident in their counseling practices.

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  Understanding Refugees' Perspectives on Health Care

  Khaled H. Al Tawil, Nathan L. Centybear, Julia Lane Cowenhoven, Emily Kinn, Joseph J. Lahey, Jayne Manigrasso, Chantal Mendes, Martha Friedman, and Shaden Eldakar-Hein

  Introduction. Burlington, Vermont accepts refugees from around the world. These individuals face unique barriers to accessing healthcare due to language, culture and finances. Research suggests that cultural beliefs about healthcare can affect ability or willingness to seek medical care. Gaining a better understanding of refugee perspectives of the healthcare system may offer insight into how to rectify this issue.

  Objectives. The goal of this study was to learn about refugee perspectives of the healthcare system and assess their use of services.

  Methods. We surveyed a convenience sample of 24 refugees to learn more about thoughts and practices surrounding healthcare and the use of the medical system.

  Results. Survey findings suggested that refugees who had been living in the US for longer than one year access healthcare resources differently from more recent arrivals. Most respondents agreed that reasons for going to a healthcare provider revolved around the diagnosis and treatment of current ailments. Regardless of time spent in the U.S., most respondents were unlikely to seek out preventive care. Refugees who had been in the U.S. longer than one year were less likely to seek out emergency services for acute symptoms that would be better served by a visit with their PCP.

  Conclusions. Recent arrivals used the emergency room for primary care needs more than those living in the U.S. longer than one year, suggesting the efficacy of provided health education. Study data suggests an important area for improvement may be increased education for refugees about the importance of preventive care.

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  Assessing the Awareness of Lead Hazards in the Greater Burlington Area

  Tessa R. Barclay, Laura Taylor Director, Steven Everse, Bailey Fay, Aaron M. Gelinne, Eliot S. Jia, Julia McGinty, Sunit K. Misra, and Lauren Pyatt

  Introduction. Lead is a heavy metal found in and around homes built before 1978, comprising more than 80% of the housing stock in Chittenden County, Vermont. Lead exposure during infancy and childhood can have deleterious effects on development. Our study assessed baseline community understanding of potential household lead hazards in Chittenden County, Vermont.

  Methods.. 123 paper, 10-question surveys were randomly administered to Chittenden County, VT residents to assess recognition of lead toxicology symptoms and awareness of lead safety programs. Scores were treated as continuous variables, demographically grouped, and analyzed using non-parametric statistical analysis (Mann-Whitney & Kruskal-Wallis). Individual questions were treated as dichotomous variables, demographically grouped and analyzed using chi-squared testing.

  Results.. 48% of survey participants understood the interaction between ADHD and lead or knew the importance of window maintenance. 54.5% were aware of the Burlington Lead Program's assistance program. Participants earning less than $60,000 and those with less than a graduate degree scored statistically lower (p

  Conclusion.. Lesser-known lead poisoning symptoms and home interventions that decrease lead exposure should be emphasized to the community. High-risk groups requiring targeted education include those who rent, have lower income and education levels. Primary care providers could serve a larger role in educating patients. Additional efforts should be made to publicize services offered by the Burlington Lead Program.

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  Stress Identification and Management in COTS Family Shelter Residents

  Kristen J. Bartlett, James Duguay, Sebastian A. Franco, Marie Kenney, Callie Linehan, Alexander W. Marchese, Rebecca Robbins, Brian J. Rosen, Rebecca Mills, Anne Brena, and Jan Carney

  Introduction. Previous studies have demonstrated that the homeless population experience higher stress levels than the general population. The goal of our study was to identify potential sources of stress for families staying with COTS, the largest service provider for the homeless and those at risk of becoming homeless in Vermont, and also to gauge potential interest in evidence-based stress-reduction strategies.

  Methods. Interviews were conducted with seven adult representatives of seven different families (of fourteen eligible) currently residing at the family shelters managed by COTS, in fall 2016. Questions included a mix of short answer items and open ended prompts. Responses that yielded quantifiable data were compiled while responses that were open-ended were qualitatively analyzed to extract core themes.

  Results. 6 out of 7 residents indicated they were at least as stressed while living at COTS as when they were homeless, and 5 out of 7 were receptive to some form of stress reduction. Common stressors included health, finances, lack of privacy, children and employment status.

  Discussion. Residents at the family shelters come from a variety of cultural and experiential backgrounds. The composition of COTS' inhabitants and their needs are in dynamic flux. Accordingly, our conclusions may not translate into the future. Our observations underscore a need and a desire for stress-reduction intervention. Thus, we recommend COTS pilot both a weekly mediation class and weekly yoga class. We also suggest the organization provide nutritional information sheets to residents and explore implementing a car share program.

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  Prenatal Lead Exposure Risk Assessment by Vermont Maternity Care Providers

  Amy M. Berkman, Brendon Kinsley, Margaret S. Johnston, Rose Kristine Leu, Niketu P. Patel, Maia Sakradse, George Zhang, Wendy Davis, and Matthew Bradstreet

  Introduction. One percent of women of childbearing age in the U.S. have blood lead levels ≥ 5 ug/dL, which are associated with maternal hypertension during pregnancy, neural tube and cardiac defects in infants, low birth weight, prematurity, and spontaneous abortion. It is unknown whether obstetrics providers in Vermont are screening their pregnant patients for lead levels and educating them on lead exposure risks.

  Objective. To gain an understanding of current lead screening practices in Vermont and issue recommendations for disseminating lead screening information.

  Methods. We developed and e-mailed a survey to practicing OB/GYN physicians, maternity care focused family medicine physicians, nurse midwives, and professional midwives. The survey assessed current screening practices for lead exposure in their pregnant patients, interest in receiving statewide guidelines, and guideline dissemination preferences.

  Results. Of the 41 respondents, 12% currently conduct risk assessments for lead exposure with all of their pregnant patients. Fifty four percent of maternity providers give all of their patients educational materials about lead exposure and risk of toxicity. Seventy one percent of maternity providers think that having guidelines provided by the Vermont Department of Health would encourage them to begin or continue lead exposure screening. The two preferred methods of communicating guidelines to physicians were grand rounds and email whereas non-physician providers preferred email and webinar.

  Discussion. The majority of pregnant patients in Vermont are not properly assessed or educated about lead risks. However, there is interest in having statewide standardized lead risk assessment guidelines, with dissemination preferences differing by provider type.

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  Willingness To Donate Blood During the Summer

  Christopher Bernard, Taylor Brown, Ramya Ghantasala, Obhijit Hazarika, Nicole Leonard, Cori Polonski, Zachary Wunrow, Michelle Heleba, Jan Carney, and Mark K. Fung

  Introduction. Each year donation rates fall in the summer months straining blood banks’ capacities to meet local demands. In hopes of identifying factors to increase summer donations, our study investigated donor reported barriers which influence summer donations habits.
  
  Methods. An anonymous 16 question survey investigating various donation factors was administered across multiple American Red Cross (ARC) donation centers in Vermont. Questions addressed donor demographics, frequency of blood donation, preference in appointment making modalities including smartphone app use, summer travel habits, willingness to donate during vacation, and factors that deter donors from donating on vacation.
  
  Results. A total of 292 surveys were received. Survey respondents across multiple demographic groups cited similar barriers to summer donation, namely “Too busy” (27.5 %) and “Traveling is a time for me to relax.” (30.6 %). Of the respondents who travel in the summer, very few reported donating while traveling (3.4 %). Summer donation rates between summertime travelers (36.5 %) and non-travelers (36.4 %) were essentially equivalent. The most preferred methods of scheduling appointments were via ARC website (45.6 %) and phone (28.4%). Willingness to use the ARC app was highest among respondents ages of 18 to 34 (45-55%) and lowest among ages 55 and older (13-15%). Of respondents with no prior knowledge of summer seasonal shortages (22 %), 2/3rds indicated newfound motivation to donate.
  
  Conclusion. Regardless of travel, increasing awareness of summer shortages may increase summer donations. Use of donor websites and smartphone apps may be instrumented as part of recruitment efforts.