Public Health Projects, 2008-present

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  The Effects of Poetry in Elderly Populations with Memory Impairment

  Michael Burton, Katherine Clifford, John P. Corbett, Midori Eckenstein, Jenna Conway Jorgensen, Stephanie S. Kulaga, Hyunsoo Joshua No, Nathaniel White, and Judith Christensen

  Introduction. A small body of research on therapeutic use of poetry in individuals with memory impairment demonstrates benefits similar to that of more widely studied music interventions. This project aims to assess the effects of participation in a poetry group on the residents of a memory care floor within the Converse Home, an assisted living facility in Burlington, Vermont.

  Methods.. We evaluated the effects of twelve group poetry sessions on residents' well-being in several domains. Each session included a reading and writing portion, which were evaluated separately to assess differences in measures of communication, interest, and enjoyment. These measures, along with negative responses, were recorded on Likert scales. T-tests, ANOVA, and post-hoc comparisons were used to compare behavioral and affective observations in the reading versus writing sessions.

  Results.. Positive responses were significantly higher in reading sessions (p

  Conclusion.. Although the limitations of this project preclude us from drawing individual conclusions regarding the therapeutic efficacy of poetry in individuals with memory impairment, we demonstrate that poetry sessions have a positive impact on global quality of life outcomes and introduction of poetry sessions in this population has a beneficial effect.

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  Public Health Outcomes as a Measure of Efficacy of Syringe Exchange Programs

  Andrew Corse, Katelyn Donaldson, Andrew Gallagher, Anita Li, Morgan R. Pratt, Benjamin F. Smith, Amelia V. Tajik, Peter Jacobsen, T. Vezina, and Jerry Larrabee

  Introduction. A syringe exchange is a public health intervention that offers nonjudgmental services to intravenous drug users (IVDU), providing clean syringes in exchange for used syringes. While prior studies demonstrated that syringe exchanges can reduce transmission of HIV, hepatitis C, and other blood-borne pathogens, other measures of health improvements have been less studied.

  Methods. 91 members of Vermont CARES syringe exchange program were surveyed on their healthcare practices. New members were defined asprogram.

  Results. Long-term members tended to have a primary care provider (PCP). Lack of insurance and fear of judgment were commonly cited reasons for not having a PCP. Long-term members were significantly less likely (p=0.04) to use costly emergency department (ED) services and less likely to reuse their own or another person's needles. Long-term members were more likely to be in addiction treatment and reported a greater desire to abstain from drug use. New members were more likely to obtain hepatitis C and HIV testing in the past year.

  Discussion. Subjects responded positively to the possibility of accessing PCP services through VT CARES, offering a continuation of the nonjudgmental healthcare environment. Decreased ED visits significantly correlated with longer membership, reflecting the positive impact of the syringe exchange education services on reducing healthcare costs. Decreased testing among long-term members may reflect prior knowledge of their status. Long-term members were less likely to reuse their own needles or ones used by another person, suggesting the distribution of clean syringes encourages safer injection practices.

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  Diagnostic Medical Errors: Patient's Perspectives on a Pervasive Problem

  Cody J. Couperus, Sree Sahithi Kolli, Sergio Andres Munoz, Quinn Self, Russell R. Reeves, Erica Worswick, Sterling A. York, and Allen B. Repp

  Introduction. The Institute of Medicine defines diagnostic error as the failure to establish an accurate or timely explanation for the patient's health problem(s), or effectively communicate the explanation to the patient. To our knowledge, no studies exist characterizing diagnostic error from patient perspectives using this definition.

  Objective. We sought to characterize diagnostic errors experienced by patients and describe patient perspectives on causes, impacts, and prevention strategies.

  Methods. We screened 77 adult inpatients at University of Vermont Medical Center and conducted 27 structured interviews with patients who experienced diagnostic error in the past five years. We performed qualitative analysis using Grounded Theory.

  Results. In the past five years, 39% of interviewed patients experienced diagnostic error. The errors mapped to the following categories: accuracy (30%), communication (34%) and timeliness (36%). Poor communication (13 responses) and inadequate time with doctors (7) were the most identified causes of errors. Impacts of errors included emotional distress (17 responses), adverse health outcomes (7) and impaired activities of daily living (6). Patients suggested improved communication (11 responses), clinical management (7) and access to doctors (5) as prevention strategies. For communication, patients rated "talk to your doctor" highest (mean 8.4, on 1-10 Likert scale) and "text message" lowest (4.8).

  Conclusions/Recommendations. Diagnostic errors are common and have dramatic impact on patients' well-being. We suggest routine surveillance to identify errors, support for patients who have experienced errors, and implementation of patient and provider "checklists" to enhance communication. Future studies should investigate strategies to allow care providers adequate time with patients.

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  Analysis of Care Coordination for Children with Special Health Care Needs: A Parent's Perspective

  Kristen M. Dalton, Desiree N. DiBella, Alan Lee, Althea L. Morrison, Adam Michael Schlauch, Marc J. Vecchio, Paige M. Wood, Lisa Maynes, and Heather Link

  Introduction. Care coordination involves organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve improved outcomes, a recent national focus. Compared to the national average, a higher percentage of Vermont children are cared for in an office that meets medical home criteria. However, there is limited research on medical home and care coordination for children with special health care needs (CSHCN) in the state of Vermont.

  Objectives. The goal of this study was to assess family perceptions, knowledge, and attitudes about how well care coordination is working for Vermont families with CSHCN.

  Methods. A paper and an electronic anonymous survey was developed for Vermont families with CSHCN. The surveys were then distributed by Vermont Family Network and the UVMMC Department of Pediatrics. Focus group interviews were also conducted at Vermont Family Network to provide family insight to explain the quantitative data.

  Results. 30 participants responded to the survey; only 20 completed it. The overall composite satisfaction score is 54%. This score takes into account 4 questions regarding care coordination satisfaction. Each question was formatted into a numerical value ranging from zero to five, with an overall score of 20 equating to 100% satisfaction.

  Discussion. Findings indicate that families with CSHCN are not satisfied with the level of care coordination currently provided. Respondents reported many barriers regarding care coordination, including lack of communication among health care providers, insurance coverage, and lack of support during transitional periods in care. Recommended improvements were identified.

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  Asthma in Vermont Dairy Farmers

  Wyll T. Everett, Victoria Lauren Close, Rebecca Merriam-Stelfox, Sravana Paladugu, Jacob B. Reibel, Ruby L. Russell, Rebecca Ryan, and David Kaminsky

  Introduction. Although 5.4% of the Vermont population participates in agriculture as an occupation, little data exists on the prevalence of asthma in Vermont dairy farmers, due to inadequate sample sizes. Previous studies have shown dairy farmers are at risk of respiratory illness due to unique exposures intrinsic to their occupation. We conducted a study to assess the prevalence of asthma in dairy farmers in Vermont, to understand rates among this population and potential occupational risks.
  
  Methods. We distributed a paper survey modeled after previously-validated surveys, such as the BRFSS, to farmers at Vermont Farmer Bureau meetings, farmers markets, and individual farmers through Cabot Creamery. Out of 309 distributed surveys, we received 176 completed surveys for a response rate of 57%.
  
  Results. Self-reported asthma rate in dairy farmers was 21% (22% in dairy only farmers), with 90% of these cases reported as confirmed by a doctor. Of non-dairy farmers, 11% self-reported experiencing asthma. Farming activities associated with exacerbation of asthma symptoms were milking, prepping or cleaning bedding, and haying. 31% of dairy-only farmers reported symptom exacerbations due to these occupational triggers.
  
  Conclusions. The prevalence of asthma in Vermont dairy farmers is one of the highest reported rates in any Vermont occupation. Our data suggest that certain occupational exposures may increase risk of asthma and warrant further study; certain farming practices were associated with exacerbation of respiratory symptoms in farmers diagnosed with asthma. These findings and further research can assist in development of health care and preventive health measures for farmers.

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  Public Awareness of Medical Imaging as a Source of Ionizing Radiation Exposure

  Tim Fields, Michael J. Hall, Arjun Janardhan, Lawrence J. Leung, Samantha Magier, Allison B. Robbins, Katie C. Warther, Razelle Hoffman-Contois, William Irwin, and Jan Carney

  Background. Biological effects of exposure to ionizing radiation (IR) are well known. Literature suggests most patients and physicians lack proficient understanding of risks associated with ionizing radiation. Our study goals were to: assess the extent to which productive, informed conversations regarding ionizing radiation are occurring between patients and providers; characterize public awareness of medical imaging procedures as sources of IR exposure; and investigate best practices in patientprovider communications.

  Methods. We developed and administered a 17-question survey to 303 adults at five locations across Chittenden County, Vermont, over a 6-week period in fall 2016. Descriptive and statistical analyses were conducted using SPSS.

  Results. The three age groups of respondents had different knowledge levels about ionizing radiation (p

  Conclusions/Recommendations. 1. A standard oral presentation for pre-imaging patient-provider communication, along with a written handout, be developed; 2. A section of the electronic medical record (also accessible through the patient portal) containing IR exposure be created for patients and physicians to track individuals' information.

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  Effects of Art from the Heart on Nurse Satisfaction and Patient Well-Being

  Kassandra J. Gibbs, Eric C. King, Nicholas S. LoSchiavo, UnChan Pyon, Jasmine Y. Robinson, Luke Soelch, Brianna F. Waller, Rebecca Schwarz, Buffy F. Dekmar, and Sarah McCarthy

  Introduction. Art programs have been shown to positively affect unit culture, quality of care, and nursing practices. Art interventions improve well-being, reduce stress, and enhance nurse-patient communication. Art from the Heart (AFTH) is an art program that provides art supplies, visual art, and patient "About Me" pages to patients, families and employees at University of Vermont Medical Center (UVMMC).
  
  Objective. Assess the efficacy of AFTH through nursing staff perceptions, understanding, and attitudes toward the program.
  
  Methods. Structured interviews were conducted on Baird 4, an adult inpatient ward, at UVMMC. A 19-question survey using Likert scales and short answer formats was administered to nursing staff. Questions assessed perceptions of effects of art on patient anxiety and pain, communication, and job satisfaction. Surveys were analyzed to extract major and minor themes.
  
  Results. Twenty-eight interviews were obtained and two major themes emerged: nurse satisfaction and patient well-being. Nursing staff satisfaction minor themes included improved productivity, promoting conversation, and creating a positive influence on the unit. Respondents reported that AFTH helped initiate conversations with patients (100% of respondents) and reduced workday stress (68%). The second major theme, patient well-being, included benefits to patients with dementia, providing comfort, and serving as an outlet or distraction. Utilizing AFTH improved perceived patient mood (100%), health (78.5%), and reduced patient anxiety (89.3%).
  
  Conclusions. AFTH provides positive benefits by reducing nursing staff stress and perceived patient anxiety; improving communication, perceived patient mood and health; and creating a sense of community. AFTH should be expanded to the entire 6 Community Agency: Burlington City Arts, Art from the Heart

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  Vermont Healthy Kids' Meals: Parents' Perspectives

  Ashley C. Hodges, Geordie C. Lonza, Lindsay S. Howe, Omkar Betageri, Ryan Erik Landvater, Sean Closs, Tina Zuk, and Paula Tracy

  Introduction. Childhood obesity has increased for decades. Options on kids’ menus in restaurants typically involve unhealthy choices such as fries, chicken fingers, and grilled cheese, with soda as the drink. When healthy options are the default choice, children are more likely to eat them. Though initially skeptical of modifications, restaurants will enact changes to maintain customer satisfaction and profits, and there is no significant difference in price of healthier kids’ meals.
  
  Methods. 187 paper and electronic surveys were administered throughout Vermont to explore attitudes towards availability, cost, and importance of healthy kids’ meals, as well as income, education, and children in the household. Open-ended questions sought parental opinions.
  
  Results. 69% of parents believe healthier food options at restaurants would cost more; however, 95% were willing to pay more. 89% of parents reported feeling concerned or highly concerned about sugary drinks, and 62% of parents were very likely to choose the healthier food option at a restaurant. The majority of parents who reported difficulty in finding healthy meals felt the amount of fruits/vegetables was the most important nutritional factor. Low income Vermonters were most concerned about cost.
  
  Conclusions. The majority of parents are concerned about kids’ meal nutrition and are likely to purchase healthier options, even at increased prices. If restaurants enact changes to kids’ menus, prices should remain the same to ensure families of all socioeconomic classes will be able to purchase healthier meals. Priority modifications to meals should include increased amounts of fruits/vegetables and elimination of added sugar.

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  Nutrition Education in Vermont Public Schools

  Garyn Worrall, Allison Greene, Suven Cooper, Francis G. Gause IV, Patrick Saunders, Daniel Lambert, Rebekah Misir, Alison Howe, and Katy Davis

  Introduction. Despite positive changes, childhood obesity and food insecurity remain prevalent across the country. Vermont is not immune to these issues. We set out to: research the level of nutrition education Vermont elementary schools provide their students, understand teacher perceptions of these programs, and recommend ways to fill identified gaps.

  Methods. Our study is a cross-sectional survey of Vermont educators around nutrition education. The survey consisted of 17 questions, used LimeSurvey, and included demographic and nutrition education questions. The survey was distributed statewide through newsletters and list-servers.

  Results. 64 responses met inclusion criteria. Vermont elementary school (K-6) teachers report a mean satisfaction score of 2.51 out of 5.0 for their schools' current nutrition education programs. School nurses reported a score of 2.5 out of 5.0. Highest satisfaction scores included school administrators and health and wellness coordinators (3.3 out of 5.0). When comparing teachers to non-classroom educators (administrators and nutrition educators) data showed a significant difference between high satisfaction (3-5) and low satisfaction (1-2); (Fischer p = 0.009). Overall, Vermont elementary school teachers report a high level of knowledge about nutrition, (4.1/5.0), but a lower level of understanding in their students (2.5/5.0).

  Conclusions. Given teacher perceptions regarding current school nutrition education programs, development and implementation of a state-wide nutrition education curriculum with dedicated teaching time may be warranted. Programs recommended by the CDC include "Eat Well & Get Moving" and "Planet Health," designed by the Harvard School of Public Health. These could be adapted as a framework for Vermont.

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  Assessing the Need for a Social Worker at the Chittenden Emergency Food Shelf

  Grace Adamson, Moshe Bitterman, Sherilyn DeStefano, Susannah Kricker, Richard Mendez, Tyler Wark, Nina Xue, Kelly Saunders, and Judith Christensen

  Introduction: Chittenden Emergency Food Shelf (CEFS)

  • Largest direct service emergency food provider in Vermont Serves over 12,000 people/year
  • Works to alleviate hunger through grocery services, hot meals, and home delivery
  • Offers a culinary job training program

  CEFS seeks to understand client need for assistance in accessing/coordinating additional public assistance services and resources. Could CEFS improve its services by staffing a social worker on site?

  Project Goal: Collect data from CEFS users to assess current need for in-house social worker to assist with diverse needs beyond emergency food assistance.

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  Slipping Through the Cracks: Receptivity of healthcare professionals to an electronic screening tool for human trafficking

  Jennifer Albert, Kenyon Bolton, Gilana Finogenov, Mateen Hakim, Julia Shatten, Abishag Suresh, Soriaya Thura, Stephen Wheat, Edith Klimosky, and Ted James

  Introduction:

  Human trafficking is the exploitation of an individual through force or coercion, for labor or services, including commercial sex.

  Healthcare providers are uniquely positioned to encounter trafficked people.

  Prior research has found a need for increased sensitivity in identifying trafficked persons in healthcare settings, and for provider education about the issue.

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  Vermont Adolescent Perception of Barriers to Smoking and Cessation

  Kathryn Anderson, Aniruddha Bhattacharyya, Nicholas Kovacs, Nicole Mendelson, Gayathri Prabhakar, Andre Robinson, Rebecca Ryan, and David Kaminsky

  Introduction: Despite a decline in youth smoking rates over the past decade, thirteen percent of Vermont high school students still smoke (Vermont Youth Risk Behavior Survey, YRBS, 2013). Smoking and nicotine exposure at an early age can have detrimental effects on brain development and lead to long term, sustained tobacco use (Arrazola et. al 2015). It was our goal to characterize the barriers to cessation for these adolescents. Some important factors suggested by the literature include living with someone who smokes (50% of VT teen smokers report a parent or guardian who smokes) and having a close friend who smokes (70% of VT teen smokers) (American Lung Association 2015). Nationally, while teen smoking rates continue to decline, the decrease is being offset by a significant increase in electronic vapor products (e-cigs) (12% increase from 2011-2014) (Arrazola et. al 2015). The 2013 Vermont YRBS data may therefore be misleading, and not capture this increase in tobacco and e-cig use. Therefore, we were particularly interested in further characterizing the link, if any, between e-cig use and smoking initiation or successful smoking cessation.

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  Naturopathic Physician Attitudes and Practices for Vaccination and Primary Care in the State of Vermont

  David Arsanious, Paul Baresel, Stephanie Brooks, Rachel Carson, Vicenta Hudziak, Stephen Maurer, Kelsey Sullivan, Chris Finley, Sarah McCarthy, and Jan Carney

  Introduction:

  Recent increase in measles cases has sparked vaccination controversy.

  Naturopathic physicians (NDs) have been recognized as primary care providers by VT since 2012.

  It is not well understood how NDs address vaccination with patients.

  Our goal was to determine how Vermont NDs address vaccines and preventative care with their patients.

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  Implementing a Fitness and Nutrition Program for Special Olympics Athletes

  Andrea Blood, Shannon Brady, Liam Donnelly, Do young Gwak, Charlotte Hastings, Astia Roper-Batker, Kasra Sarabakhsh, Stephen Shenouda, Justin Graham, and Stephen Contompasis

  Introduction:

  Only 17-30% of individuals with ID meet the recommendations for daily exercise

  Populations of individuals with ID have higher BMI, lower cardiovascular fitness and lower muscle strength compared to the general population

  Individuals with ID also have many dietary challenges necessitating nutritional education and interventions

  One study following four athletes with ID, showed that pairing athletes with and without (unified sports) resulted in a positive change in social self-concept for athletes with ID

  Given the above, we:

  Created a 6-week pilot training and nutrition program for Special Olympics Vermont (SOVT).

  Paired athletes with ID with college athletes without ID to promote wellness during the athlete’s off season.

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  UVM Tobacco Use and Attitudes After Implementation of a Tobacco-Free Policy

  Christina Cahill, Elizabeth Carson, Eric Day, Melissa Rafferty, Saraga Reddy, Anthony Sassi, Eric Schmidt, Tom Delaney, Burton Wilcke, and Jan K. Carney

  Introduction: Widespread public health initiatives have led to falling smoking rates. Currently, 1,620 U.S. colleges have adopted smoke-free policies. In August 2015, the University of Vermont (UVM) adopted a tobacco-free policy that bans all forms of tobacco use on university property. The purpose of this study was to compare tobacco use and attitudes before and after policy implementation.

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  The Digital Age: Reminder and Confirmation Preference in Blood Donation

  Michael Chung, Catherin Hayes, Peter Hyson, Y-Lan Khuong, Saurabh Patel, Brett Powers, Emily Ryan, Ryan Schmoldt, Jan Carney, and Mark Fung

  Introduction:

  It is widely accepted that individuals are more likely to comply and follow through with responsibilities when reminded and asked to confirm their commitments. With the American Red Cross’ access to fast and affordable communication and this notion in mind, there is potential to develop new recruitment strategies and better methods of ensuring blood donation commitments.

  In particular, understanding modes of communication with the donor population can have significant implications: avoiding loss of follow up, improving donor experience, and ensuring appropriate use of resources and staff; therefore, the American Red Cross is interested in understanding demographic differences among those who prefer different modes of communication for blood donor appointment reminders and confirmations.

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  Living in Recovery:Perceptions of Health Care and Comorbidities in Rural New England

  Theodore Cisu, Elizabeth Doughty, Rahul Gentyala, Kathleen Olson, Kishan Patel, Taylor Wolfgang, Richard Yun, Gary DeCarolis, and Jill Jemison

  Introduction:

  Alcohol and Drug Abuse: In the USA, abuse of tobacco, alcohol, and illicit drugs is costly, exacting more than $700 billion annually in costs related to crime, lost work productivity, and health care.

  9% of Vermont residents and 8% of US residents report alcohol or illicit drug abuse, and 10% of US adults consider themselves to be in recovery from drugs or alcohol.

  Health Care and Recovery: Persons with drug addictions are approximately twice as likely to suffer from mood and anxiety disorders compared to the general population.

  Aside from mental health disorders, other common comorbidities include dental problems, insomnia, and migraines.

  The majority of people in recovery report having a primary care physician, but they receive fewer preventative health care interventions compared to the general population.

  The Turning Point Center of Chittenden County: The Turning Point Center is a non-profit organization that provides a safe, substance-free environment and peer-to-peer recovery activities to assist in recovery from addiction.

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  Lake Champlain Water Quality: A Study of Public Awareness, Perceptions, and Behavior

  Kelley Collier, Tridu Huynh, Michael Ialeggio, Colby Kearl, Autumn Reilly, Dana Ribaudo, Elaine Wang, Razelle Hoffman-Contois, Andrew Chevrefils, and Jan Carney

  Introduction: Lake Champlain serves as a major source of drinking water and a prime recreational area in Vermont. The Vermont Department of Health actively monitors Lake Champlain water quality, generates informational resources, and issues restrictions and advisories as necessary. Key water quality issues include: blue-green algae blooms (BGAB), combined sewer overflow (CSO), mercury-based fish consumption advisories, and suitability for recreational use. Determining public awareness of Lake Champlain water quality, and how perceptions of Lake Champlain water quality influence behavior, are essential to improving communication with at-risk and underinformed populations.

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  Nutrition in Early Childcare Programs: The Benefits and Barriers

  Patrick Cruden, Timothy Flanagan, Emily Forbes-Mobus, Xiaoyu Lu, Alison Mercier, Siyeon A. Seong, Yazen Qumsiyeh, and Alison Howe

  Introduction:

  1 in 5 Vermont children experience food insecurity. Inadequate nutrition threatens cognitive, social, and emotional development in the first years of life.

  49.1% of Vermont children arrive at kindergarten underprepared. It has been shown that undernourished children have reduced activity levels and withdraw from their environment, removing them from critical learning opportunities and social interactions.

  Supporting the provision of healthy food in early childcare programs may help address the issue of food insecurity and promote healthy childhood development.

  Currently, there are no existing data on both Vermont childcare providers and parents of these children on their perceptions of the importance of providing food in early childcare programs as well as the associated benefits and barriers to do so.

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  Effects of Art Intervention on Pediatric Anxiety and Pain in the Medical Setting

  Ashley L. Deeb, Miles W. Grunvald, David A. Leon, Anton Manyak, Lindsay R. Miller, Kelsey M. Veilleux, Lisa H. Wang, Buffy F. Dekmar, Rebecca Schwarz, and Shaden Eldakar-Hein

  Introduction: Hospitalization and illness can be a painful and stressful time for a child. There may be anxiety over procedures and inpatient stays disrupt normal routines. Previous research found that for pre-school aged children, having parents around, having the help of the hospital staff, and playing an active role in alleviating their fears were the most helpful in reducing anxiety. Another study found that visual creative expressions can be meaningful experiences for young adult cancer survivors. Additionally, there is abundant literature on formal art therapy and its favorable effects on children in the hospital, however, there are fewer studies investigating less standardized “art intervention” in the same population. The purpose of our project was to assess whether art intervention reduces anxiety and pain in inpatient and outpatient pediatric patients.

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  Parental Perceptions of Oral Health and School-Based Dental Sealant Programs

  Laura Donnelly, Peter Evans, Ian Grant, Allicia Imeda, Daniel Kula, Clare Park, Hao Fang Wu, Julie Cole, Kristin Fontaine, and Wendy Davis

  Introduction:

  Community Health Needs Assessment (University of Vermont Medical Center, 2013)

  Identified oral health in pediatric population as a primary concern

  Barriers to dental care cited: access, affordability, education School-Based Sealant Program (SBSP)

  Dental sealants are an evidence-based method of cavity prevention

  CDC strongly recommends delivery via SBSPs

  Few Vermont schools have such a program

  Vermont Medicaid State Plan amendment allows dental hygienists to bill without on-site dentist (2015)4

  Unique opportunity to pilot an SBSP

  Pilot program implemented by the University of Vermont Medical Center Community Health Improvement

  Goal: sustainable model able to be replicated in Vermont schools Pilot School Selection – Milton Elementary-Middle School (MEMS)

  Demographics representative of Vermont schools (46% free & reduced lunch program); school administration supportive of an SBSP; no existing dental education (“Tooth Tutor”) program per Vermont Office of Oral Health

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  Characterization of Hypertension Risk Factors at the Committee on Temporary Shelter

  LIndsey M. Eastman, J. Curtis Gwilliam, Ethan R. Harlow, Adrienne R. Jarvis, Jacob Korzun, Michael K. Ohkura, Samantha M. Siskind, Brianna L. Spencer, Tim Coleman, and Virginia L. Hood

  Introduction: The health of homeless populations is at risk due to a high prevalence of undiagnosed hypertension (HTN) and cardiovascular disease (CVD). The interaction of housing and socioeconomic status with the risk factors for HTN and CVD remains unclear. Prevention of HTN through a healthy diet, exercise, adequate sleep, and avoidance of tobacco has been well described, but financial limitations and competing priorities for shelter and food make blood pressure (BP) control difficult for this population. By characterizing the risk factors and awareness of hypertension within the homeless population at the Committee on Temporary Shelter Daystation (COTS) in Burlington, Vermont, we may be able to identify promising avenues for therapeutic intervention.

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  Facilitators and Barriers to Prescribing PreExposure Prophylaxis (PrEP) for the Prevention of HIV

  Theresa B. Flanagan, Margaret M. Graham, Tihn T. Huynh, Derek L. Luzim, Alexandra K. Miller, David M. Nguyen, Yueyue Shen, Peter Jacobsen, and Jerry Larrabee

  Background:

  What is PrEP and who gets it?

  PrEP is the use of medication by individuals to prevent HIV contraction, approved in 2012 after demonstrating safety and efficacy in the iPrEx study and Partners PrEP2 trials.

  HIV infection risk is 92% lower in patients using PrEP.

  Truvada®, a combination of tenofovir and emtricitabine taken orally daily, is the only approved PrEP regimen and is intended to compliment other prevention strategies such as condoms.

  HIV negative-individuals at risk for exposure to HIV have been identified as men who have sex with men (MSM), IV drug users, heterosexuals who have unprotected sex with partners of unknown HIV status, and those in serodiscordant relationships.

  Barriers to PrEP Implementation

  PrEP is effective when patients adhere; however, both the medical community and some high-risk populations have been slow to adopt it as an HIV prevention strategy.

  Surveys have shown clinicians perceived barriers to PrEP such as adverse side effects, viral drug resistance, increased high-risk behavior, cost, and training.

  HIV in Vermont

  New diagnoses of HIV among Vermont residents has remained relatively stable over the last twenty years.

  Vermont CARES, a non-profit, offers free and anonymous HIV tests and in-person risk-reduction counseling. Clients are increasingly asking about PrEP as a prevention strategy, but the response from the medical community is difficult to ascertain.

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  Oral Health Intervention: A Multifaceted Approach to Improve Oral Health Care during Pregnancy

  Tabitha Ford, Gregory Frechette, Sruthi Sakamori, Caleb Seufert, I-hsiang Shu, Patrick Silveira, Wendy Davis, and Kristin Fontaine

  Introduction:

  Early Childhood Caries (ECC) is the most common chronic disease of childhood

  Mothers’ oral health status is a strong predictor of the oral health status of their children

  2009:

  Vermont spends $2.7 million treating children ages 0-5 with Early Childhood Caries

  2012:

  Vermont lifts the $495 Medicaid cap on reimbursement for a woman’s dental care during pregnancy and up to 60 days after delivery

  American College of Obstetrics and Gynecology (ACOG) Guidelines on prenatal dental care are published

  2013:

  74% of surveyed Vermont providers treating pregnant women are unaware of the Medicaid change

  82% of these providers are not using guidelines to assess oral health during pregnancy

  Objective: To improve prenatal dental referral rates from obstetric providers by facilitating Vermont-specific implementation of ACOG guidelines

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  Addressing the Opioid Crisis in Vermont: Lessons Learned from Primary Care Physicians

  Tim Henderson, Molly Markowitz, Adam Petchers, Brittany Rocque, Andrew Sheridan, Nathanial Sugiyama, Lyndsey Wyatt, Elizabeth Cote, Charles MacLean, and Jan Carney

  Background:

  Opioid Misuse in Vermont:

  The number of Vermonters seeking treatment for opioid abuse is increasing, particularly in Chittenden County.

  Emergency department visits and deaths related to opioid misuse continue to increase, both locally and nationally.

  Opioid Addiction Treatment:

  The Drug Addiction Treatment Act (2000) was passed to allow physicians to prescribe buprenorphine-naloxone for opioid addiction, termed Office-Based Opioid Therapy (OBOT).

  OBOT has been shown to be a highly effective treatment for opioid addiction.

  The Hub and Spoke model was implemented in Vermont to connect specialty treatment centers with outpatient OBOT providers.

  Project Goal: To identify barriers to providing OBOT that primary care physicians (PCPs) face in Chittenden County, Vermont.