Public Health Projects, 2008-present

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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.

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  Vermont Restaurant Owner & Manager Perspectives on Creating Heart-Healthy Kids Meals

  Elisabeth Lucas, Mary K. LoPiccolo, Lauren Haggerty, Apoorva Trivedi, Alex Jacobson, Daniel Trigg, Taylor Sommer, Carolyn Payne, Tina Zuk, and Paula Tracy

  Introduction: The prevalence of sugar sweetened beverages and fried foods combined with a lack of healthy children’s menu options has contributed to the obesity epidemic among young Americans. Recent legislation in New York City and San Francisco instituted strict nutritional requirements on children’s menu items.

  We performed a cross-sectional study that focused on independently owned restaurants with printed children’s menus in Vermont. We investigated the nutritional content of children’s menu items, restaurant owner and manager perspectives on customer ordering habits, and barriers that restaurants would face if they made children’s menu items healthier.

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  Healthcare Barriers of Residents at a Subsidized Housing Community

  Curtis T. Adams, Amy M. Hopkins, Daniel J. Ianno, H. Omer Ikizler, Kristi Kilpatrick, Jani M. Kim, Sargis Ohanyan, Sarah K. Russell, and Virginia Hood

  Introduction: Despite expanded healthcare programs, the low income and elderly lack coverage of vision, hearing, and dental services. Community services are often asked to fill these gaps. To evaluate the situation in Burlington, VT, we surveyed staff and residents in Burlington Housing Authority (BHA) subsidized housing to (1) identify gaps in healthcare coverage and (2) assess barriers to accessing those services in this population.

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  Vermonters’ Opinions on Low-Dose CT Lung Cancer Screening

  Benjamin Albertson, Eric Bennett, Homer Chiang, Erin Keller, Katherine Lantz, Melanie Ma, Sharon Mallory, Rebecca Ryan, and David Kaminsky

  Introduction: Lung cancer is the number one cause of cancer death among men and women in Vermont and the United States. Smoking increases the risk of lung cancer—nearly 90% of lung cancer is due to smoking. Frequently, lung cancers do not present clinically until they are advanced stage and therefore prognosis is poor. However, if detected early lung cancers are more operable and patients have better outcomes. In December 2013 the US Preventive Services Task Force released new guidelines for lung cancer screening among current and former smokers ages 55 to 80. It is recommended that current and former (within 15 years of quitting) smokers of 30 pack years receive an annual low-dose CT scan. The objective of this project was to assess the level of knowledge and attitudes towards lung cancer screening with low-dose CT scanning among Vermonters in the Burlington area.

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  University of Vermont Community Tobacco Use and Attitudes Survey

  Hillary Anderson, Kyle Concannon, Catherine LaPenta, Robin Leopold, Christina Litsakos, Imelda Muller, Asaad Traina, Tom Delaney, Burton Wilcke, and Jan K. Carney

  Introduction: Smoking remains an important public health issue in U.S. Colleges. 17.3% of U.S. smokers are 18-24 years old. 28% of U.S. college students began smoking at age 19 or older. Currently 1,104 U.S. Colleges have adopted Tobacco-Free policies.

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  A Life Skills Toolkit: Curriculum Development for Sustainable Public Health Community Engagement

  Muhrtaza Bharmal, Bryce Bludevich, Tracey DaFonte, Jonathan Hernandez, Jill Jemison, Sarah Kelso, Tristan McKnight, Ryan Nichols, Christopher Williams, Margaret Schwalbaum, and Luke Zitterkopf

  Introduction: Committee On Temporary Shelter (COTS) is a community organization that provides gateway housing opportunities to fourteen previously homeless veterans through its Canal Street program in Winooski, VT. Many of the residents struggle with physical fitness, poor nutrition, and mental illness, including PTSD. Research has shown that there is an increasing prevalence of overweight or obese veterans returning from service, and these individuals present a particular challenge to primary care physicians as their mental health issues are closely related to their level of fitness. It has been demonstrated that veterans often suffer from ingrained food insecurity, which negatively influences post-service eating behavior, and readjustment solutions are needed to ease reentry into civilian life. While literature recommendations exist outlining the important role of initiating easy-to-use exercise programs and the beneficial impact of exercise in a natural environment on veterans, there has been little research into more holistic approaches to improve the diminished quality of life impacting many individuals with PTSD. Recent literature shows decreased PTSD symptoms after a life skills intervention and that short-term nutritional education interventions have the capacity to favorably change eating behaviors in a low income population. Therefore, we decided that a comprehensive, yet personalized intervention was needed.

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  Public Perception of Pesticide Exposure in Vermont

  Nicholas Bonenfant, Ayse Celebioglu, Bridget Colgan, Pierre Galea, Lucas Grover, Joshua Weaver, Tom Delaney, Razelle Hoffman-Contoi, Linda Boccuzzo, Heidi Hales, Jan Carney, and Razelle Hoffman-Contois

  Introduction: A pesticide is any substance intended for preventing, destroying, repelling, or mitigating any pest.1 The public generally believes that insects, diseases, and other pests need to be controlled but is also becoming concerned about the impact of pesticides on their health and the local ecosystem. Pesticide exposure occurs with public and private use. Studies indicate consumers have diverse levels of awareness, knowledge, and attitudes regarding pesticide use and health risks.2 The goal of this project is to identify levels of awareness, knowledge, and attitudes toward pesticide usage in Vermont to help State agencies focus public awareness and education.

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  Evaluating Communication Tools and Increasing Fruit and Vegetable Consumption in Vermont Head Start Classrooms

  Meghan Breen, Leah Cipri, Troy Larson, Laura Leonard, Andy Liu, Will Manning, Kai Ping Wang, Isobel Santos, Jennifer Fink, Missy Kuncz, and Andrea Green

  Introduction:

  We designed a program for four Head Start classrooms that aimed to: 1) Provide classrooms a tool that would facilitate communication with families about nutrition, 2) Educate families about the MyMeal tool, and 3) Increase fruit and vegetable consumption by providing families with fresh fruits and vegetables Fruit and vegetables are important components of a healthy diet, and sufficient consumption helps reduce the risk of developing cardiovascular disease, cancer, diabetes and obesity. Eating behaviors during childhood are highly parentally influenced and function as the foundation for future eating patterns. Studies have shown that the extent to which fruits and vegetables are present and accessible in the home correlates with the amount of fruit and vegetables eaten by children.