Public Health Projects, 2008-present

All posters from the UVM Larner College of Medicine Public Health Projects, 2008 to present.

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Bridging the Gap: Improving the relationship between social service organizations and healthcare providers

Gabriela Bosmenier Cruz, Linda L. Cui, Liberty J. Dupuis, Ian Guertin, S. Halsey, Ying K. Loo, Finlay Pilcher, and Joaquin Reategui

In Vermont, a significant social determinant of health is rurality. Barriers to healthcare services include distance to providers, lack of integration with social services, and failure to recognize community needs.

Integration and robust collaboration between healthcare and social services can likely improve outcomes for individuals who have high utilization of both categories of services.

Understanding relationships between healthcare and social services may provide an important framework for translating interventional research to rural communities to improve health equity.

Project Goal: To understand barriers affecting collaboration between social service providers and community health providers in order to promote research-based improvements in health outcomes in rural populations.
Vermont School Districts Meal Service Response to COVID-19

Stephen Brand, Will D. Buick, John E. Fernan, Gina Jin, Rebecca Lapides, Jennifer Lor, Paul McCleary, and Timothy L. Long

The COVID-19 pandemic has posed many challenges worldwide, including lack of food access and security. Food insecurity in Vermont has increased from 18% to 24% since the outbreak of the pandemic.

Food insecurity among families with school-aged children puts children at risk for developmental delays, poor social functioning, and poor academic performance.

The goal of this project is to identify the challenges that the COVID-19 pandemic has posed for meal distribution services in school districts across Vermont, recognize the adaptations that were made by schools to address these challenges, and determine which adaptations had positive effects to encourage widespread implementation of these and other strategies to maximize food security for school-aged children nationwide.
Attitudes Toward Informational Health Videos among People with Intellectual Disabilities

Sydney M. Cardozo, Julie P. Connor, Jake Ermolovich, Tyler A. Harkness BS, Anneliese Lapides, Jack F. Mangan, Nicole Obongo, and Maxwell T. Tulimieri

An intellectual disability (ID) can be defined as a limit to a person's ability to learn and function in daily life when compared to an expected level. Due to these differences, a person with ID can face more challenges in daily life, including those that impact their health.

Special Olympics Vermont (SOVT) is an organization that hosts athletic events and competitions for people with an ID. We worked with them to formulate a plan for providing educational resources for people with an ID.

We created educational videos with corresponding one-page pamphlets containing material and imagery that was relatable to the athletes with ID, to inspire positive changes in their health habits.

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

We created surveys that evaluated the reception of the educational videos, whether athletes learned from the videos, and if they planned on incorporating what they learned into their lives.
Improving the Accessibility and Efficacy of the UVMMC CHNA to Populations Experiencing Homelessness

Rachel Carpenter, Jamie A. Cyr, William Kim, Megala Loganathan, Weida Ma, Dinukie-Chantal Perera, Sean Taylor, and William J. Yakubik III

Under provisions in the Affordable Care Act, tax-exempt hospitals are required to conduct a triennial Community Health Needs Assessment (CHNA) to identify and prioritize the health needs of the community served. UVMMC is preparing to conduct the 2022 CHNA and is exploring best outreach approaches to marginalized or historically underrepresented populations within Chittenden and Grand Isle counties.

Research Question: What actions can be taken to effectively understand the diversity of needs in the homeless population of Chittenden County?

Hypothesis: The current CHNA incompletely captures how health barriers are disproportionately experienced by the homeless population in Chittenden County.

Goals: Identify best practices and tailor outreach methods to better assess the needs of the homeless population.
No Fall Too Small: Assessing Barriers to Fall Prevention Programs

Christina Cobb, Arley Donovan, Heather G. Giguere, Arjune Singh Nibber, Brian L. Shaw II, Aathman Swaminathan, and Ryan Warner

In Vermont, 1/3 of adults 45 years or older fell in the year 2018, statistically above the national average, which has not changed since 2012. Of those who fell, 34% experienced an injury after their fall.

Evidence-based interventions and fall prevention programs effectively reduce falls, and these programs aimed at reducing falls appear to reduce fractures. In fact, it has been shown that exercise intervention reduces fall risk by 30%.

Our review of the literature highlighted that there are numerous barriers to accessing fall prevention programs, including loss of independence, transportation, cost, and lack of interest. With this in mind, we investigated the potential barriers to accessing and attending fall prevention programs in Vermont.
Naturopathic Medicine in Vermont's Healthcare System: A Thematic Analysis

Trevor D. Coles, Tayler Drake, Rose Eiduson, Daniel J. Fried, Max C. HoddWells, Simran Kalsi M.S., Mahima R. Poreddy, and Clifford A. Reilly

Naturopathic Medicine is a system of health care that utilizes education, natural medicines, and natural therapies to support and stimulate a patient's intrinsic self-healing processes and prevents, diagnoses, and treats human health conditions, injuries, and pain.

There are 5 accredited schools of naturopathic medicine in the US and 2 in Canada. Naturopathic physicians were recognized as primary care providers (PCP) in 2009. There are 355 NDs licensed in VT, and 88 NDs with a VT address. 81% participate in Medicaid.

OBJECTIVE: To explore the role of naturopathic physicians in Vermont's healthcare system
Addressing the Needs of Sara Holbrook Community Center Caregivers

Stephen J. Foley, Shubhankar Joshi, Ankrish Milne, Izabella Ostrowski, William Robinson, John A. Steinharter MS, Rachel A. Wayne, and Alayna M. Westcom

Previous research: parental stress can negatively impact behavioral and cognitive development of children.

Each year, over 4,000 people use SHCC resources: preschool, after school care, teen programs, food shelf, ESL services, etc.

SHCC supports families at the center itself, but many families still experience difficulties at home that contribute to caregiver stress.

The purpose of this study: understand the needs of the caregivers of students who attend SHCC and propose actionable solutions to address the top identified needs.
Assessment of SNAP Utilization and Accessibility in Vermont

Amanda Galenkamp, Mohamad K. Hamze, Elie Kaadi, Elise A. Prehoda, W. Evan Shaw, Nicole A. Walch, Shari J. Zaslow, and Paula Tracy

Food insecurity exemplifies one of the many public health crises that the COVID19 pandemic both exposed and amplified. In 2019 an estimated 10.5% of households (13.7 million households) were food insecure as determined by the US Department of Agriculture (USDA) including 5.3 million children. In 2020 this number increased to 15.6% of households, including 17.0 million children as projected by Feeding America. Food insecurity in children, especially in infancy, is associated with the development of obesity and hyperlipidemia, highlighting the necessity of federal and state food assistance programs.

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

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

An integrative and comprehensive approach to pain management seeks to advance patient outcomes with respect to quality of life, pain management, mindfulness, and physical function. This biopsychosocial approach is an evidence-based medicine modality that has been executed to be cost-effective and targeted to meet individual patient values. Participants can enroll in integrative pain intervention modalities to treat their chronic ailments; examples include Acceptance and Commitment Therapy, PT, OT, nutrition, reiki, hypnosis and yoga. In a systematic evaluation of integrative health projects, Turk et al. concluded interdisciplinary programs yielded better outcomes than traditional pain treatments.

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

Based on our data, we believe further investigation into the benefits of Integrative Medicine is warranted for the advancement of patient outcomes with respect to pain management.
What’s Going on with E-cigarette use in Vermont High Schools?

Fay Abdullah, Elizabeth Baumgartner, Delaney Curran, Noorin Damji, Madeline Fritz, Catherine Gereg, Ray Mak, Shayan McGee, Alex Crimmin, and David Kaminsky

The use of electronic cigarettes (e cigarettes) has become popular practice among teenagers in the United States. E cigarettes have been marketed as a “healthier” alternative to traditional cigarettes and include several flavor options to make them more appealing to teenagers. However, studies have shown that e cigarettes are still harmful, leading to addiction, nausea, vomiting, headache, and upper airway irritation. Most recently, the outbreak of severe lung illnesses is believed to be related to e cigarette use; the CDC and FDA are investigating the cause of this outbreak.
E-cigarette and tobacco use on a tobacco-free UVM campus

Sameer Alidina, Lauren Gernon, Kalin Gregory-Davis, Alexa Pius, Olivia Quatela, Samuel Raszka, and Zeynep Tek

The prevalence of e-cigarette use has significantly increased in recent years. In the US, e-cigarettes are now the most common nicotine products used by adolescents. The CDC reported 1,299 cases of lung injury correlating to the use of e-cigarette and vaping products; the current recommendation is to refrain from using e-cigarette products that contain THC and/or nicotine.
Food Security in the COVID-19 Era

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

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

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

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

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

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

Amelia Anderson, Lauren Bougioukas, Alexander Braun, Adam Morehead, Collins Oguejiofor, Christina Sanchez-Grew, Rachel Tobin, Jenny Lamping, and Mark Fung

Understanding the influences of social determinants of health (SDOH) on blood donation may help define the relationship between health in a community and rates of blood donation. While much is known about the demographics of blood donors in the United States, their SDOH have not yet been studied. Research examining SDOH outside the United States has found that many factors influence the likelihood of blood donations. These factors include education, income, health insurance, health status, and marital status. The aim of this study is to examine U.S. blood donors’ SDOH such as emotional support, stress levels, physical safety and access to food, housing, and healthcare, as well as identify trends between these factors and donation frequency.
Physician Attitudes Toward Screening for Social Determinants of Health

Michael Barnum, Rosie Friedman, Tierra Lynch, Collin Montgomery, Irene Sue, Jenna Wells, Hakeem Yousef, Elizabeth Cote, and Charles Maclean

Social determinants of health (SDH) have a significant impact on health outcomes. Screening for SDH in the clinical setting can identify at-risk patients, but follow-up and management remain challenging. Currently, there is no single preferred screening tool recommended for SDH and the screening process varies widely. The goal of this study was to determine family medicine physician attitudes and practices regarding screening and follow-up for SDH in Chittenden County, VT.
Trends in Buprenorphine Use and Barriers to Medication-Assisted Recovery

Isi Beach, Richard Brach, Carolyn Geraci, Kyle Leonard, Rose Martin, Nikkole Turgeon, Faith Wilson, Kayla Donohue, and Mariah McNamara

Since the initiation of the "Hub and Spoke Model" in 2014, VT has been able to eliminate the waitlist for receiving Medication-Assisted Recovery (MAR) and has increased the number of MAR providers. However, many people still report using non-prescribed “street” MAR prior to entering treatment to avoid withdrawal from opiates. Our study aims to assess current trends and barriers to access in buprenorphine use.
Development of a Sustainable Volunteer Model to Address Food Insecurity

Abigail Belser, Adrian Berg, Leah Miller, Kaitlyn Peper, Allison Tzeng, Carolyn Gould, Linda Howe, and Jan Carney

Food insecurity is a predictor of poor health outcomes and a critical social determinant of health. Food shelves are critical community resources aimed to counter food insecurity by providing nutrition and other resources to those in need. Food insecurity in Winooski, Vermont is substantial and increasing, with 10% of residents utilizing the Winooski Food Shelf (WFS) in 2018. To aid in the increasing demand of the WFS, we determined the greatest need(s) to implement a sustainable intervention to ensure capacity to meet demands.
Assessing Burnout in Early Childhood Educators

Megan Boyer, Sarah Clark, Emma Hall, Malla Keefe, Elena Martel, Michael Tabet, Mohammad Wali, Sarah Adams-Kollitz, and Molly Moore

The stress of working as an early childhood educator can manifest as increased job turnover and burnout, leading to reduced teaching efficacy. Resilience training can increase wellbeing and decrease stress. This study assessed burnout, resilience, and organizational constraints at Burlington Children’s Space (BCS), a childcare education non-profit.
Assessing the Feasibility of a Peer Developed Risk Reduction Plan in a Rural Middle School

Sara Brennan, Christian Brooks, Patrick Clarke, Isaac de La Bruere, Nicole Delgado, Alexandra Kuzma, Emma Levine, Joanna Jerose, and Leigh Ann Holterman

Sheldon Middle School (SMS) reported above-average suicidal ideation and risky behavior (e.g., sexual activity, alcohol use) on the 2017 Youth Risk Behavior Survey, compared to state levels. Current literature highlights programs designed to reduce risky youth behavior. Little research exists on the feasibility of designing and implementing peer-created, peer-driven intervention programs. There is a gap around parent and faculty opinions surrounding the feasibility of these programs. We investigated the feasibility of partnering with students to design an empirically-based program that addresses some root causes of risky behaviors, then measured parent and faculty attitudes.
Housing Initiatives Implementation in Vermont to Improve Health Outcomes

Jose Calderon, Marlijne Cook, Benjamin Kagan, Sylvia Lane, Maha Saleem, Kayla Sturtevant, Angela Troia, Heidi Klein, and Jan Carney

Vermont Department of Health goals include improving population health outcomes, including social determinants of health. There is compelling evidence between housing and health; research demonstrates housing insecurities increase rates of negative health outcomes. Research further demonstrates improve-ments in housing reduce hospital stays, thus reducing financial burdens on hospitals. This project sought to understand what housing initiatives Accountable Communities for Health (ACH) in Vermont are implementing to alleviate the burdens of housing insecurity.
Primary Care Perceptions: Health Services for Vermonters with Intellectual Disabilities

Magalie Carey, Gia Eapen, Adam Fakhri, Taylor Marquis, Cara Rathmell, Claudia Russell, Nicole Wershoven, Elizabeth Cote, Mike Reilly, and Stephen Everse

Champlain Community Services (CCS) provides developmental services and health care to Vermonters with intellectual disabilities (100 individuals in 2019), offering coordinated one-to-one support at work, home, school, and in the community. The goals of this study were to learn which services local primary care practitioners believe to be most beneficial to patients with intellectual disabilities (ID), to identify barriers to developmental services, and to gauge practitioners’ familiarity with CCS.
Attitudes & Roles Regarding Firearm Access and Suicide Prevention in Vermont Middle & High Schools

Cari Carpenter, Kelly Chan, Jeremy Greenberg, Alyssa Heiser, Ashleigh Peterson, Peter Twining, Emerson Wheeler, Kristin Fontaine, and Wendy Davis

Adolescent suicide is a serious public health concern in Vermont, and the presence of firearms in the home is a known risk factor. Suicide attempts with firearms are more likely to be completed than attempts with other means, with an 85% mortality rate of suicide with firearms compared to 5% with other means. This project aimed to assess attitudes, comfort, and perceived roles among school personnel in addressing gun safety and access to firearms with Vermont students and parents.
A Comprehensive Needs Assessment of Rural Syringe Services

Deena Chanowitz, Julia Clemens, Alim Esemenli, Matthew Hill, Erick MacLean, Adessa Morano, and Adam Ross

The current opioid epidemic has resulted in a significant increase in opioid-related overdoses, and a corresponding rise in HIV and HCV transmission. Syringe Service Programs (SSPs) provide resources for people who inject drugs. There are fewer SSPs in rural U.S. and little research has been conducted to determine unique needs of SSP participants in rural areas.
Addressing Vermont Childhood Obesity Through Public Policy: Scoring Vermont Supervisory Union Wellness Policies Using the WellSAT Assessment Tool

Olivia Cooper, Rachel Harrison, Jugerta Istrefi, Colby McGinn, Micheal Mikheal, John O'Keefe, PJ Tran, Tina Zuk, and Paula Tracy

As of 2016 the state of Vermont has required all public school supervisory unions to have a wellness policy guiding nutritional and physical education, nutritional quality of food served and sold, and the implementation and modification of the policy in the future. We hypothesize that differences between these policies throughout the state of Vermont will lead to changes in health outcomes for the students that they impact.
HPV and Cancer Prevention: It’s Not Just About the Warts

Matthew Dier, Elizabeth Hahn, Rachel Madhur, Francis Mtuke, Carley Mulligan, Lauren Schlussel, Kristina Valentine, Bill Couzens, and Jan Carney

Human papillomavirus (HPV) infections are responsible for 34,000 cancers per year throughout the United States, including cervical, anal, vulvar, vaginal, penile, and oropharyngeal cancers. In 2018, only 51% of adolescents received all recommended doses. Our study goal was to assess knowledge of HPV in a population likely well-informed about cancer risks.
Assessing Prenatal Care Providers’ Promotion of Immunization in Pregnancy

Emily Eakin, Francesca Garofalo, William Holden, Sunny Hutson, Ambrose Orr, Melanie Parziale, Anya Srikureja, Emily Straley, Christine Finley, Jill Jemison, and Raj Chawla

Accurate information regarding prenatal immunization is critical for first-time mothers. Many vaccine-hesitant mothers decide whether to vaccinate their children during pregnancy. The Centers for Disease Control and Prevention (CDC) guidelines urge providers to recommend the Tdap and influenza vaccines to pregnant patients to reduce the risk of complications from pertussis and influenza, respectively, in both expectant mothers and infants. In 2018, about half of pregnant women in the US received an influenza vaccine and Tdap vaccine; however, uptake varies state to state. This study demonstrates the first survey of providers regarding prenatal immunization practices in Vermont.