Public Health Projects, 2008-present

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  3 Squares VT Food Assistance Usage by Patrons at the Chittenden Emergency Food Shelf

  Ashley Atiyeh, Elizabeth Blasberg, Katelyn Cushanick, Daniel Edberg, Mairin Jerome, Patrick Ng, Rob Meehan, and Jan Carney

  • The federally funded 3SquaresVT program (formerly Food Stamps) increases access to healthy food and helps to stimulate local economies. • 10.9% of Vermont households are food insecure and 15.8% of children live in food insecure households. • Many families are eligible for 3SquaresVT but choose not to enroll, hurting Vermont’s economy and stressing charitable organizations like the Chittenden Emergency Food Shelf (CEFS).

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  Depression in the Elderly: Attitudes of Seniors and Practices of Healthcare Providers

  Jacob Azurdia, Jocelyn Hu, Elisabeth Kispert, Autumn Polidor, Matthew Saia, Matthew Thomas, Richard Tan, Molly Dugan, Tom Delaney, and Patricia Berry

  Introduction: Support & Services at Home (SASH) is a model for independent housing for seniors that was developed in 2009 by a partnership of community providers and Cathedral Square Corporation. Results of a 2010 PHQ-9 screen on depression administered to seniors living at Heineberg Senior Housing, a Cathedral Square community, found that 30% of residents had mild depression, 6% moderate depression, and 6% moderate to severe depression. This topic has been targeted by SASH coordinators so that they may provide more support for their residents. Furthermore, a high prevalence of depression amongst the elderly population has been well-documented and this disease is often under-diagnosed, under-treated, or missed altogether.

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  Huntington’s Disease: Assessing The Needs of Patients and Caregivers in Vermont

  Agnes Balla, Caitlin Baran, Larry Bodden, Joseph Foley, Kelly Gardner, Laura Rabideau, Christopher Taicher, Benjamin Ware, Jim Boyd, and Linda Martinez

  Introduction: Huntington’s disease (HD) is an inherited neurological disorder that causes a progressive decline in motor, cognitive and psychiatric function. • HD affects 30,000 people in the USA. In Vermont it is estimated that 69 individuals have HD and 420 people are at risk for developing the disease. • Crescent Manor Care Centers is currently the only long term care facility in Vermont that houses Huntington’s patients. Patients receive care specific to HD including PT, OT, Speech Therapy and community activities. Currently, 13 of 40 beds are occupied. • There is one HD support group in the state located in South Burlington which meets once a month. Due to the low population of HD patients in the state, there is no single state government agency responsible for managing the care of HD patients.

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  Assessing Health Needs of the Burlington Probation and Parole Population

  Nicole Benson, Katelynn Ferranti, Laura Frischer, Jonathan Galli, Kevin Kuruvilla, Stanislav Lazarev, N. J. Louras, Herb Sinkinson, and Jill K. Jemison

  The Burlington Probation and Parole population confronts numerous social, economic, and healthcare challenges upon their return to the community. While health and healthcare issues of inmates have been studied extensively, the health status and medical issues of the reentry offenders, particularly in rural areas have not been previously assessed. Data about health risks, major medical issues, and lifestyle choices among offenders on parole in the rural setting may prove helpful in the identification of preventative measures and development of strategies to promote positive health behaviors among the target population. The aim of this study is to evaluate the health risks among offenders on parole in the Burlington area and guide recommendations towards improving their health outcomes through community and educational initiatives. We also sought to gain a better understanding of the barriers within the rural setting that prevent positive health behaviors among the parolees upon their reintegration into the community

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  Assessing Bullying Behaviors and the Efficacy of Bullying Prevention in Fourth Grade Classrooms

  Amanda Boutrus, Alyson Guillet, Chelsea Harris, Duong Hua, Rola Khedraki, Aaron Maxwell, Prabu Selvam, Jordan Smith, Stephen Contompasis, and Deb Lyons

  Introduction: Bullying has recently gained notoriety as a serious concern across all countries. Bullying is generally acknowledged to be a repeated pattern of abuse communicated to a victim by physical, verbal, or written means which results in bodily harm or emotional injury. Victims of bullying have been shown to be at increased risk for suicide, depression, anxiety, headaches, or difficulty sleeping. Puppets in Education (PiE) is a non-profit organization that uses interactive puppet shows and workshops to educate more than 8,000 children per year about disabilities, cultural diversity, and a wide variety of other issues. By performing its shows in classrooms throughout the state, PiE works to model realistic, challenging situations for children and to provide simple and practical strategies for dealing with them. Focusing our attention on the effects of bullying behaviors in schools, our team worked with PiE and several local fourth grade classes to determine the amount of information children retain from the organization’s bullying prevention program, the effectiveness of the program in addressing and preventing bullying behaviors, and the students’ overall perception of the program.

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  Breathing Easy: Lung Health and Associated Conditions in the Day Care Setting

  Richard Carrick, James Corbett-Detig, Anastasia Coutinho, Justine Hum, Gunter Krauthamer, Sarah Marsh, Gerald Davis, and Rebecca Ryan

  Introduction: Air pollutants are associated with many health risks. Children in the day care environment are uniquely suscept-ible to lung damage, infection, systemic illness & pollutant triggered hypersensitivity reactions. The latest public report by the CDC reports Vermont’s (VT) asthma rate is the high-est in the country at 11.1%. This project compared VT’s day care regulations regarding specific environmental factors linked with health risks to regulations in six surrounding New England states. We sought to assess whether VT’s regulations adequately protect children in day care

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  Community Pediatrics and Growing Kids South Burlington An assessment of collaboration between area pediatricians and integrated services for families of young children in South Burlington, VT

  Leah Carr, Wendy Davis, David Drimmer, Joey Hager, Hannah Foote, Nicholas Koch, Jerry Lee, Elizabeth Meyer, Dane Slentz, and Anjali Varigonda

  Background: It is widely accepted for pediatric and family medicine practitioners to use developmental screening tools for effective identification of children who require additional support. A recent study in Pediatrics reported that between 2002 and 2009, the percentage of pediatricians using standardized screening tools for developmental delay increased from 23.0% to 47.7%. While improvement was found, less than half of pediatricians used these tools. In addition, it is known that early intervention for children requiring extra support is essential for preventing further delay in reaching milestones. Practitioners’ use of screening tools and their collaboration with their community resources can contribute to better delivery of these services and aid in children meeting developmental milestones.

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  Screening for Alzheimer’s Disease in Vermont Primary Care Practice

  Bryan Chow, Anne Coleman, Daniel Liebowitz, Mairi Lindsay, Hayk Minasyan, Michael Mollo, Ashley Russo, Jeanne Hutchins, William Pendlebury, and Martha Richardson

  Introduction: • Alzheimer’s Disease (AD) is a form of progressive dementia that affects 5.3 million Americans and is the sixth leading cause of death in the US. • Age is a major risk factor for disease , and 1 in 8 Americans over 65 can expect to develop AD. • The U.S. healthcare system spends $172 billion/year on patients with AD and dementia, more than half of the Medicare budget. This cost is estimated to increase to over $1 trillion by 2050. • In 2003, the US Preventative Services Task Force (USPSTF) concluded that screening older adults for dementia is ineffective due to insufficient means of preventing or slowing its progression. • In 2011, the National Institute on Aging published new diagnostic criteria for AD. • In accordance with these guidelines the Centers for Medicare and Medicaid Services released rules for the new Annual Wellness Visit that include the detection of cognitive impairment. • Our goal was to identify the attitudes and practices of primary care physicians (PCPs) in Vermont (VT) related to screening for AD and dementia.

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  Exploring Barriers to Exercise among Adolescents at the Burlington Boys and Girls Club

  Peter Cooch, Nazia Kabani, Vincent Kan, Gabriel Morey, Therese Ray, Sara Staples, Jack Stackhouse, and Pam Farnham

  Introduction: The Boys and Girls Club of Burlington (BGCB) is a non-profit that holds after-school activities for adolescents, including music, art, technology, and sports. The BGCB has struggled to encourage physical activity (PA) among many participants. We designed our study to identify deterrents to PA, as well as possible ways to improve participation.

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  Should 16-Year-Olds Be Allowed to Donate Blood? A Vermont Perspective

  Gabriel Crowl, Anees Daud, Vanessa Franz, Nicholas Phillips, Maia Pinsky, Jennifer Pons, Areg Zingiryan, Carol Dembeck, Chris Frenette, Jan Carney, and Mark K Fung

  Introduction: Supplying adequate blood for transfusions is an ongoing challenge for blood collection agencies. One potential source of increased Whole Blood (WB) supply is among 16-17 year-olds, whose donation rates are still quite low. In 2010, donors aged 16-18 years-old provided 14% of all WB collected by the American Red Cross. Young donors may represent an opportunity to establish a committed, long-term blood donation base as they are more likely to return after first donation and donate at a higher yield rate than older donors. However, younger donors also have higher rates of adverse events during donation. Currently, 38 states allow 16 year-olds to donate blood with parental consent but Vermont is not among them. Our study examines the public’s comfort with 16 year-olds donating blood. As blood donation is a voluntary system, ascertaining the perspective of the general population regarding this issue could contribute to a policy debate surrounding the minimum age of donation.

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  Cremations, Dental Amalgams, and You

  Calvin Kagan, Alison Krywanczyk, Xingfu Liang, John Malcolm, Molly Rovin, Bianca Yoo, Bailey Zhao, Jan Carney, Razelle Hoffman-Contois, and Heidi Hales

  Introduction: In Vermont, cremation has increasingly become an alternative to interment of an intact body. Many of the bodies being cremated contain dental amalgams, which are commonly used by dentists to repair dental erosion and caries (cavities). They are an economical option for caries repair, and remain popular. Roughly one third of all caries fillings done in 2002 in the U.S. utilized amalgam. Amalgam is a metal alloy containing as much as 50% mercury by volume, a metal that is a known toxicant. Dental amalgams, may constitute a source of low level, continual exposure for those with these dental devices in situ and may be released to the atmosphere upon cremation. The goal of this project was to investigate: 1. The status of the scientific opinion on potential health effects that may be associated with having dental amalgams. 2. To help refine State estimates of potential mercury emissions from Vermont crematoria.

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  Assessing Barriers to Healthy Food Access in Winooski, VT

  Michael Lam, Anurag Shukla, Margaret Gordon-Fogelson, Heather Lutton, Griffin Biedron, Andrew Ng, Bethany Collins, Kate Nugent, Hendrika Maltby, and Jan Carney

  Introduction: • The local food environment plays an important role in defining the health of the neighborhood and is an important determinant of resident’s dietary intakes. • Specifically, food availability, affordability, and accessibility have been linked to diet quality and various health outcomes. • Fresh fruits and vegetables are markers for nutritional diets. Grocery stores and super markets tend to have better quality fruits and vegetables, greater variety and better affordability than convenient stores that tend to have more prepared and higher calorie foods. • People who live in neighborhoods with better access to supermarkets tend to have a greater daily intake of fruits and vegetables. • Increased distance from supermarkets is negatively associated with healthy food intake in a study of pregnant women. • “Food deserts” are areas that are devoid of a local supermarket where residents have a limited ability to purchase affordable healthy foods. They have become an emergent problem in the United States. This paucity of supermarkets in these areas combined with lack of private or convenient transportation among poorer residents may contribute to health disparities across socioeconomic classes. • The town of Winooski, VT has a population of 7,267. Although there are local food markets and convenient stores within the town, Winooski lacks a larger grocery store. • Insufficient public transportation and inadequate pedestrian sidewalks make it more difficult for residents to access supermarkets located in other towns.

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  Barriers to Complete Adult Vaccinations in Vermont

  Bhanu Muniyappa, Nicholas Wilkie, Ashley Miller, Katherine Anderson, Mayu Toner, Francesca Boulos, Michelle Force, Christine Finley, and Burton Wilcke

  Introduction/Background: • Child immunization is nearly universally accepted as an effective preventative measure against infectious diseases, yet adult immunization rates continue to lag behind recommended levels. • Epidemiological trends suggest a correlation between vaccine administration and decreased rates of significant morbidity and mortality, hospitalization and emergency department visits, work absenteeism, and illness associated expenses. • As of 2010, Vermont is failing to meet its adult immunization goals by 13-43%. • This study aims to understand and identify specific barriers to adult immunization in Vermont.

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  Assessing Barriers to Healthy Living in Economically Challenged Communities of the Greater Winooski Area

  Idil Aktan, Catherine Naber, Shetal Patel, Phillip Perrinez, Joshua Pothen, Alexandra Swartz, Janice Gallant, and Hal Colston

  Introduction: NeighborKeepers (Winooski, VT) is a non-profit, anti-poverty organization that focuses on building supportive friend networks that direct families and individuals toward the resources they need to improve their health, get training and education, find jobs, and discover a sense of purpose and belonging. Keeping with the NeighborKeepers philosophy of giving those in need the tools to help improve their own circumstances, our project goals were to: •Engage community members •Connect individuals with community resources geared toward healthy living and improved healthcare access •Identify health needs and potential areas for intervention or further inquiry

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  Increasing Senior Enrollment in 3SquaresVT

  Mohammed Almzayyen, Mark Dammann, Javier De Luca-Westrate, William Jeffries, Jeffrey McLaren, Diana Mujalli, Stell Patadji, Melissa Romero, and Angela Smith-Dieng

  Background: Hunger Free Vermont’s mission is to feed more Vermonters, teach the community about healthy food and nutrition and lead advocacy and education efforts to end hunger in Vermont. In Vermont 11.4% of all seniors are considered food insecure. To address this issue, Hunger Free Vermont has taken on the task of increasing enrollment in 3Squares Vermont, the state food stamps program. 68% of people in VT who are eligible for 3SqVT are enrolled. Surprisingly, only 29.2% of eligible seniors are enrolled. Our study focuses on the leaders of community organizations who impact seniors. Through focus groups we assessed their: - Knowledge of the 3SqV program - Knowledge of senior enrollment and food insecurity - Ideas about the barriers leading to low enrollment - Solutions

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  Emergency Department Use Among Vermont Homeless Families

  Jonathan Ameli, Emily Crook, Ashleigh Kennedy, Megan Gray, Jared Sutherland, Jonathan Thomas, Grace Chi, Pam Farnham, Liz Smith, and Annika Hawkins

  Background: Committee on Temporary Shelter (COTS) houses homeless individuals and families from the Burlington area. COTS believes that a high proportion of their residents use the Fletcher Allen Health Care Emergency Department (FAHCED) for their health care more frequently compared to the general population. There are many other primary care services offered in the Burlington area, such as Safe Harbor Clinic, Community Health Center, and private offices, which are more appropriate for non-emergent health concerns and are readily accessible to the homeless population. By surveying the population of homeless families in Burlington and conducting a focus group with the COTS staff, we hoped to discover the reasons for ED usage, potential barriers to primary health care, and any possible changes that could ameliorate the health care of this population

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  Assessing Barriers to Community Pediatric Dental Needs

  Elisabeth Anson, Aaron Burley, Samantha Couture, Katherine Irving, Stephen Morris, Darryl Whitney, Pam Fenimore, and Jill Jemison

  Introduction: Oral health is an often overlooked aspect of healthcare with many effects on an individual’s well-being. Dental caries is the most common chronic disease in children, and most dental problems are preventable. Barriers to accessing dental care for low income children include: oral health beliefs of parents, transportation issues, and difficulty locating providers who accept Medicaid. Investigation of the pediatrician’s role showed an increase in dental visits among children who were recommended for care by their primary care providers. Recent data indicates that 67.1% of Vermont Medicaid enrolled children received dental care within one calendar year. While indicating a gap in services, this is the highest rate in the U.S. A comprehensive national survey found that 85% of Vermont children received preventive care in the past year, while recent state data shows that 18% of Vermont children on Medicaid and 16% of children overall have untreated dental decay. In 2009, The Ronald McDonald House Charities, along with the Health Center of Plainfield, implemented the Vermont Ronald McDonald Care Mobile (RMCM), a traveling dental clinic providing dental care for Vermont’s underserved children. In one year, the RMCM visited 15 Vermont schools and treated 214 children, only 9% of the 2400 children projected. The RMCM currently serves sites in three Counties: Grand Isle, Orange, and Lamoille. The objective of our study was to investigate barriers to access to Dental care among Vermont children, with particular regard to the RMCM. The underutilization of the RMCM was assessed by researching current data on Vermont oral health and by surveying overall attitudes toward both the RMCM and Towns the RMCM visited in the past year pediatric dental care in Vermont.

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  Exploration into Expanding the Burlington SASH (Seniors Aging Safely at Home) Program

  Robert Areson, Vicash Dindwall, Christopher Duncan, Erin Hayes, Emily Keller, Tiffany Kuo, Susanna Thach, Susan Vargas, Tom Delaney, Molly Dugan, and Patricia Berry

  Background: In 2009, the Cathedral Square Corporation partnered with community provider organizations* to design a model for in-home services and support known as Seniors Aging Safely at Home (SASH). This comprehensive program, implemented at Heineberg Senior Housing in the New North End of Burlington, VT., combines health support, education, and social activities to create a safe and fulfilling environment for participants. Cathedral Squareplans to extend their SASH program to New North End (NNE) seniors residing in their own homes. However, the current and future needs of the NNE senior population (defined here as individuals age 50 and older) are not well known. NORCs are communities in which the population has aged in place, resulting in a high proportion of seniors living in one area. Neighborhoods with this dynamic have begun to organize programs which provide a variety of services to their seniors, including yard-work, educational workshops, social opportunities, and access to health care services. Village models are similar, but tend to be designed more intentionally as senior-supporting neighborhoods rather than arising naturally as the local population ages. By looking into current community models and by investigating the needs of the NNE senior population, Cathedral Square will be further equipped to offer important services to those who are interested.

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  Identifying Feasible Interventions to Prevent Long-Term Health Consequences of Psychotropic Medications Prescribed to Children at the Baird School

  Irina Arkhipova-Jenkins, Andrew Harris, Lindsay Kleeman, Anna Meyendorff, Jesse Victor, Jared Winikor, Katie Wright, and Rodger Kessler

  Introduction: •Many children with behavioral needs struggle in traditional classroom settings. Children receive help through specialized educational institutions, pharmacotherapy, and psychiatric counseling. •While substantial information exists about drug indications and side effects, there is little literature documenting the barriers caregivers face in addressing side effects •Our group conducted a literature review to identify the side effects and associated comorbidities of the six most frequently prescribed psychotropic drugs at the Baird School. •We designed a survey to assess the caregivers’ resources and barriers to minimizing these side effects, and then offered a collection of feasible recommendations.

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  Heads Up: Using Your Brain When Tackling Concussions

  Charles Ashley, Matthew Davies, Shane Diamond, Lauren Gilligan, Alberto Gutierrez, Lindsay Karr, Christina Pedro, Brenda Perkins, Colleen Wise, and Jan Carney

  Introduction: A concussion is a type of traumatic brain injury (TBI) typically caused by bio-mechanical forces inflicted on the head that change the way the brain works. Concussions can also result from a blow elsewhere in the body causing an impulsive force transmitted to the head. These types of injuries often involve a sudden onset of neurologic function impairment such as confusion, amnesia, or loss of consciousness that quickly dissipates and is generally not life-threatening. Unfortunately, these seemingly “mild” symptoms have led numerous primary care providers to undermine its potential risks, often leading to inadequate evaluation, premature return to play, and poor psychological management. Complications of severe or repeated concussions include migraines, depression & mood changes, sleep disorders, convulsions, coma, and in some instances even death. The goals of our study were to evaluate public awareness and knowledge of concussion, identify common misconceptions, assess barriers to proper management, and propose uniform guidelines for education, prevention, diagnosis, and treatment to be used in the Vermont school system.

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  Menu Planning and Grocery Shopping for People Living with Psychiatric Disabilities

  Nkem Aziken, Michael Boggs, Leslie Bradbury, Christopher Cahill, Sara Higgins, Lynsey Rangel, and Sandra Steingard

  Introduction: •The HowardCenter in Burlington, Vermont is designed to empower and improve the lives of individuals with mental illness throughout Chittenden County. •People living with chronic psychiatric disabilities have higher mortality rates and earlier onset of medical illness. It has been observed that many of the risk factors for chronic conditions revolve around nutrition, implying a chance to intervene. •Understanding the various ways people with psychiatric disabilities eat, buy, cook, and value a healthy diet is fundamental for the Howard Center to address increased mortality in this population. •Our goal is to identify barriers and develop a resource to improve nutrition in this population.

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  Promoting Physical Activity and Nutrition in Adolescents

  Feliecia Bahadue, Serena Chang, Bryan Clark, Victoria Lindstrom, Iwan Nyotowidjojo, Joseph Rosenberg, Allison Smith, Nancy Drucker, and Stuart Offer

  Introduction/Background: In the United States, childhood obesity has become the leading pediatric chronic disease. Increased caloric intake and decreased energy expenditure is hypothesized as contributing to the upward trend of obesity. Independent of adult weight, obese children have increased morbidity and mortality from metabolic syndrome as adults. Individuals engaging in exercise programs as short as 6 months have shown improvement in risk factors including body fat mass, waist/hip ratio, ambulatory systolic blood pressure, fasting insulin, triglycerides, and low-density lipoprotein ratio. In our study, adolescents were taught a foundation of health and well-being that incorporated regular exercise. Nutrition was taught through an evidence-based systems approach, including lessons about the cardiovascular, musculoskeletal, and gastrointestinal systems. Our aim was to improve adolescent food choices and increase physical activity through interactive educational sessions.

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  Puppets in Education

  Mena Bakhit, Jessica Clem, Mayo Fujii, Meghan Garcia-Webb, Taylor Lincoln, Ariana Nesbit, Amanda Schwartz, Peymaun Vakhshoorzadeh, Deb Lyons, and Steve Contompasis

  Introduction: •Autism spectrum disorders (ASD) are a group of related brain-based disorders that affect a child's behavior, social and communication skills. •In 2009, approximately 1,000 Vermont students received special educational services for ASD. •Puppets in Education (PiE) is a non-profit group that teaches kids how to keep themselves safe and healthy and to appreciate each other’s differences. •PiE’sFriend 2 Friend Program (F2F) addresses ASD in fun and interactive puppet and workshop presentations, promoting empathy for individuals on the autism spectrum by modeling, labeling, explaining and normalizing differences, and teaching prosocial communication and friendship skills. •Last year, UVM COM students collaborated with PiE to determine how the use of puppets could best educate the community regarding ASD. •This year our goals were to elicit: --the perceived effectiveness of current ASD education in the classroom --the perceived effectiveness of including children with ASD in the classroom; and --the most important aspects of ASD to address in the Puppets in Education (PiE) curriculum

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  Well Water Safety: A Study in Public Awareness

  Naiara Barbosa, Griffin Boll, Chantell Hemsley, John Hoyt, Michael Lahey, Razelle Hoffman-Contois, William Bress, and Jan Carney

  Introduction: Although 30-50% of Vermont citizens rely on private wells for drinking water, there is no state requirement for regular contaminant testing. As a consequence, it is possible that private well users may be exposed to a variety of potential health hazards, including bacteria, arsenic, fluoride, and radionuclides. Our group sought to better understand public awareness of testing recommendations, how often private well users have their wells tested, and what obstacles may be keeping them from doing so. With this information we hope to learn more about how Vermonters are using private wells, and how we can better serve public health in Vermont

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  Understanding Factors Contributing to Suboptimal Rates of Childhood Vaccinations in Vermont

  Adam Bensimhon, Kuang-Ning Huang, Paul Jarvis, Jonathan Jolin, Catherine Kelley, Kurt Schaberg, Cristine Velazco, Marianne Burke, and Christine Finley

  Introduction: Nationally, childhood immunizations have proven themselves invaluable in preventing contagious diseases and their associated morbidity and mortality. Nonetheless, vaccines have become increasingly controversial, with a growing number of parents refusing to vaccinate their children. Primary reasons given for vaccination refusal include fears of side effects and the belief that the target diseases are not harmful. Those parents who refuse to vaccinate their children generally have higher levels of education and income. An additional population of under-vaccinated children who have received limited recommended vaccinations has been identified and often comes from a lower socioeconomic level. Unimmunized children have been associated with recent disease outbreaks, placing other individuals at risk and increasing the controversy about childhood vaccinations. Nationally, Vermont has one of the highest rates of unvaccinated children with recent data showing these rates are continuing to increase.