Public Health Projects, 2008-present

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  Factors Identified by Lapsed Donors that Might Influence Donor Return

  Krista Buckley, Mohammed Jafferji, Matthieu Larochelle, Louisa Mook, Haddon Pantel, Laura Sturgill, Luke Vierthaler, Carol Dembeck, Christine Frenette, Jan Carney, and Mark K. Fung

  Introduction: The Burlington Chapter of the American Red Cross estimates that 8,000 donors a year become "lapsed," or fail to return for further donation. To better target this population and retain current donors, it is essential to identify reasons for lapsed donation. Several studies have been conducted on the barriers to retaining blood donors, revealing these common factors: past physical reactions, convenience, previous deferrals, lack of awareness, medical reasons, time, satisfaction with the experience, too impersonal, and personal benefit. While many studies have identified reasons for lapsed donation, the majority have not used free text as their data source, have been conducted in a wide range of geographic locations not specific to Vermont residents, and have focused on reasons for discontinuing donations, rather than positive factors. Using free text limits the question bias and eliminates constraints that predefined answers enforce. In 2007, Balderama et alconducted a study identifying common motivations for donating blood, which included an unanalyzed free text portion. We used this free text to answer the question, “What factors identified by lapsed donors might influence donor return?”

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  Emergency and Scheduled Respite Care for Caregivers of Persons with Dementia: A Proposed Program

  Olivia Carpinello, Bridget Collins, Jennifer Covino, Daniel Fischer, Angelica Santos, Kyle Schoppel, Aleksey Tadevosyan, William Pendlebury, and Linda Martinez

  Introduction: Respite care is defined as providing the primary caregiver with relief or a reprieve from care commitments on a short-term or emergency basis. Despite a demonstrated interest in and need for respite care programs, our research has shown that scarce resources exist via a statewide dementia respite program administered by Vermont’s five Area Agencies on Aging. Grants are small and many families do not fall within the eligibility requirements. In FY2010, only 290 families across the state met eligibility requirements (physicians’ diagnosis of dementia, income less than 300% of poverty line, unpaid caregiver, primary residence in VT) and were awarded limited funding for the provision of outside care (up to $750.00 each). For many of these families, this money is typically used to provide substitute care when the primary caregiver is not available. To date, there is no true emergency respite program in place for caregivers. This has placed a strain on families and day facilities, particularly when situations arise in which a caregiver is unable to pick up their family member due to an emergency situation. Our goal was to demonstrate the feasibility of a respite program to address this need.

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  Advance Directives and End-of-Life Care: Completion, Conversations, and Concerns of Burlington Housing Authority Residents

  Katherine Clark, Gwendolyn Fitz-Gerald, Claire Frost, Benjamin Goldstein, Eric Kalivoda, Sarah Persing, Damian Ray, Sarah Russell, Claire Rutenbeck, and Gerald Davis

  Introduction: •An Advance Directive is a document that allows patients to declare their wishes regarding medical care and decision making should they become unable to communicate their preferences due to an accident or illness. •The Patient Self Determination Act, passed in 1991, requires that health care institutions, such as hospitals and nursing homes, inform patients of their rights to make health care decisions, the hospitals policies regarding recognition of Advance Directives, and educate the staff and community about advance care planning. •Despite the passage of this legislation, completion of Advance Directives remains low. It is estimated that less than 25% of adults nationwide have completed an Advance Directive.

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  Removing Barriers to Health Care: Healthy Starts for New Americans

  Delia French, Matthew Graf, Jeremy Korsh, Harry Kreider, Erica Pasciullo, Katie Shean, Emily Wood, Jon Bourgo, Hendrika Maltby, and Jan Carney

  Objectives: • To determine if refugees completing a Medical Orientation Program for New Americans are better with several aspects of medicine in the US, such as making appointments; knowing more about diet and hygiene; and understanding the implications of mental and chronic illnesses. • To determine if Medical Passports provided to these individuals to improve continuity of care are useful and effective. • To make recommendations for improvements to the Medical Orientation Program for New Americans to the Community Health Center of Burlington (CHCB).

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  Tough Cookies: Hands On Nutrition at Woodside Juvenile Rehabilitation Center

  Maura Adams, Meghan Beucher, Colleen Gerrity, Brock Libby, Ronald Masson, Michael McQuiggan, Johann Patlak, Laura Piper, Alan Rubin, and Judith Christensen

  Background: Woodside Juvenile Rehabilitation Center provides a safe and secure environment to teenagers who have been remanded here by the court system for either short or long term care. We focused on nutrition at the center, particularly the evening snacks provided. The foods teens choose to eat are extremely important as total nutrient needs are higher in adolescence than during any other time in the life cycle. Little prior research on the nutritional beliefs or habits of institutionalized youth has been done. Our goal was to improve the provided snacks, as some staff members were concerned that these were not healthy. Nutritional value of food is not a priority for many teens, despite the fact that they are usually well informed about good nutrition. Rather than simply dictate a menu change, we also attempted to assess and possibly modify esident attitudes regarding healthy food. We hoped to both provide a more nutritionally healthy environment and to each knowledge and skills that would lead to long-term physical and emotional benefits in an at-risk population.

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  Double Red Blood Cell Donation Eligibility and Interest

  Laura Anderson, Kovi Bessoff, Brandon Chapman, Angela Dunn, Michael Larochelle, Tessa Scripps, Jessica Wood, Christine Frenette, Carol Dembeck, Jan Carney, and Mark K. Fung

  Introduction: The process of double RBC donation by apheresis (DRBC), which facilitates the donation of two units of red blood cells (RBC) in a single donation session, was estimated to account for approximately 4% of blood donations in 2005, and is believed to be growing at a rate of 40% per year. Blood shortages in this country could be corrected by converting as few as 10% of current single unit whole blood donors to DRBC donors. Advantages of DRBC donation may include reduction in donor-related exposures in recipients, improved cost-effectiveness of the donation process, and improved convenience for donors. The safety profile of DRBC has been found to be equal to, and in some cases better than that of single unit whole blood donation, especially in young donors (/o). DRBC donors have been shown to restore 92% of RBC volume in 4 weeks without iron supplementation, and to have no significant differences in hemoglobin, serum iron, or ferritin when compared with single unit whole blood donors six months after donation. Our study seeks to quantify the number of current single unit whole blood donors who are both eligible for and interested in DRBC donation.

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  Physician Screening for Intimate Partner Violence in Vermont

  Aleksey Androsov, Jessica Chao, Kira Fiset, Erin Hickman, Amy Huckins-Noss, Daniel Kim, Amy Kravetz, Makeda Semma, and Scott Warhit

  Introduction: The term intimate partner violence (or IPV) refers to a threat of abuse or actual psychological, physical, and/or sexual abuse perpetrated by a former or current intimate partner. IPV is an important public health issue that crosses socioeconomic lines. Approximately 4.8 million women experience physical or sexual assault perpetrated by their intimate partner each year in the US. There are no reliable statistics for how many women suffer psychological abuse, but the numbers are likely much higher. Physical, psychological, or sexual injuries can have wide ranging effects, including increased mortality. Although it has been firmly established that the prevalence of IPV is high, physician involvement in screening and diagnosing IPV has historically been very low. Previous studies have addressed IPV screening in other parts of the country. In one study, less than 15% of female patients reported being asked by a health professional about IPV, even though studies have shown that the majority of female patients would reveal their abuse if asked. Also, most physicians screened for IPV when the patient presented with physical trauma, but few screened all patients regularly. The more aware physicians were about IPV, the more likely they were to screen in all clinical settings. While both men and women are victims of IPV, and IPV can have a large effect on the children of the abused, only the screening and treatment of women was explored here. The purpose of this study was to examine the state of IPV screening in Vermont. The objectives were as follows: - ?Estimate the IPV screening, intervention, and policy practices of Vermont physicians ?- Examine the role of physicians in screening and intervention ?- Explore physicians’ knowledge of IPV resources

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  Assessing Barriers to Utilization of Adult Day Care Centers in a Rural County

  William Ares, Michael Hart, Derek Huang, Laurel Karian, Maria Michael, Auna Otts, Donna LaFromboise-Perretta, and Jill Jemison

  Introduction: Adult Day Care programs provide cognitively or functionally impaired adults with medical, social, and therapeutic services as well as offer valuable respite and education to family caregivers. The Visiting Nurse Association’s Adult Day program manages three centers that offer these services and are located in Colchester, Williston, and South Burlington. We have explored the underutilization of these centers by comparing variables such as demographics, services provided, referrals, transportation constraints, and satisfaction surveys between centers and to national success guidelines for adult day services.

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  Identifying barriers to care in the Burmese and Bhutanese refugee populations of Burlington, Vermont

  William Arscott, Brian Costello, Kathryn DiPalma, Alex Folkl, Megan Malgeri, Amanda Miller, Rebecca Purtell, Jon Bourgo, and Rodger Kessler

  Introduction: Many refugees who escape persecution in their own country have trouble navigating and accessing the American health care system. Language barriers often impair effective communication, while financial challenges can be prohibitive after the eight-month government insurance subsidy for new refugees expires. In addition many refugees do not understand the concept of chronic disease, which is a concern considering the overall rise in hypertension (HTN) and type-two diabetes mellitus (T2DM) in the US population. Understanding how refugees access health care, and how well they understand chronic disease, is essential for organizations providing medical care for these populations. Little is known about how the Burmese and Bhutanese refugees experience the Vermont health care system, nor how well they understand chronic diseases such as HTN and T2DM. To address these limitations, we conducted focus groups with these two Vermont refugee populations at the Community Health Center of Burlington, Vermont (CHCB).

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  The What’s, Where’s, and Why’s of What Your Family Eats: The Burlington Children’s Space Farm To Table Program

  Loren Babirak, Kelly Cunningham, James Dunlop, Jenny Nguyen, Cheddhi Thomas, Zea Schultz, Michael Visker, Nancy Drucker, and Barbara Frankowski

  Introduction: Preventing childhood obesity is a national priority, and changing dietary behavior in both children and adults is challenging. Burlington Children’s Space, Inc. (BCS), a private, non-profit early education and childcare center providing services for families in the Burlington area, is trying to do just that. The Farm to Table Project was designed to positively influence the food choices of students and their families as well as to cultivate a relationship between families and local farmers. In an effort to secure expanded funding for the school’s food program, BCS requested that we assess the effectiveness of their Food Program

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  Assessing the Current State and Potential Needs of the Community for Autism Spectrum Awareness in the Classroom

  Megan Berube, Adam David, Shannon DeGroff, Sharif Nankoe, Kaitlin Petros, Steven Schaub, Scott Wasilko, Deb W. Lyons, and Stephen Contompasis

  Introduction: • Number of children with autism and related disorders has been growing in Vermont in the last ten years. • Puppets in Education, Inc (PiE) recently added a new program Friend 2 Friend Programs-Vermont (F2F), that will work with grades K?8 to educate students and teachers about autism spectrum disorders (ASD). • Goal is to promote understanding, acceptance, empathy and mutual friendships between children with ASD or other social communication disorders • Students from the University of Vermont College of Medicine partnered with PiE to evaluate the current needs of the community, determining what information would be most useful in the F2F program.

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  Bisphenol A and Phthalates: Public Knowledge and Risk Perception

  Marissa Bucci, Katie Casas, Emily Colgate, Holly Gunyan, Lincoln Heath, Matthew Hoffman, Ryan Smith, Bill Bress, Razelle Hoffman-Contois, Jan Carney, and Charles Hulse

  Introduction: Bisphenol A (BPA) and phthalates are chemicals used in the production of many plastics, including food containers, water bottles, and medical intravenous tubing. These chemicals can leach from the plastic, especially when heated, and are found in varying concentrations in the human body. There is concern about the widespread exposure to BPA and phthalates since studies indicate they may cause adverse health effects, particularly related to endocrine development and regulation in young children.

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  Are Mandates the Answer? Improving Palliative Care and Pain Management in Vermont

  Patrick O. Butsch, Laura C. DePouli, Nicholas A. Larochelle, Mckalyn G. Leclerc, Michael A. Maccini, Michael P. Morwood, Andrea M. Steely, Virginia Hood, George Philips, William Wargo, Tom Delaney, and Jan Carney

  Background: The Vermont legislature (bill H.435, Sec. 19) has tasked the Vermont Board of Medical Practice (VBMP) with making a formal recommendation on improving Vermont health professionals’ knowledge and practice of Palliative Care and Pain Management (PC/PM). In collaboration with the VBMP, our group set out to answer the following questions: • How confident/competent are VT physicians in the practice of PC/PM? • What are the barriers to achieving optimal patient care in PC/PM? • Do VT physicians believe mandatory CME would improve the overall quality of care in PC/PM? • What are the best methods of providing Continuing Medical Education (CME)?

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  Nutrition and Social Eating Habits Among Seniors Living Independently

  Carl Cappelletti, Lindsay Corse, Aaron Kinney, Suleiman Lapalme, Nolan Sandygren, Danielle Scribner, Mariah Stump, Tom Delaney, Margaret Holmes, Molly Dugan, and Patricia Berry

  Background: Older adults have unique nutritional needs due to physiologic changes that occur as part of the normal aging process. Maintaining adequate nutrition has the potential to reduce morbidity and mortality related to chronic disease, fall risk, dementia and Alzheimer’s disease. Aging also poses an increased risk of isolation and lack of social interaction, particularly noted at meal times. Unintentional weight loss is an independent risk factor for early mortality. Social eating is related to higher food intake, and meal programs can improve nutritional risk for vulnerable seniors. We partnered with the Cathedral Square Corporation (CSC) to assess nutrition and social eating in residents at Heineberg Senior Housing in Burlington, VT and conducted focus groups to determine general nutritional concerns and evaluate potential interventions.

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  Food Shelf Friendly: Increasing the Nutritional Quality of Food Shelf Donations

  Daniel Carballo, Anne Kamarchik, Lindsay Nadeau, Isaac Noyes, Marianne Reed, Louisa Salisbury, Nathaniel Ward, Rob Meehan, and Jan Carney

  Introduction: Food insecurity is a household-level economic and social condition of limited access to nutritionally adequate and safe food. Food banks provide a major source of sustenance for individuals experiencing food insecurity, many of whom deal with obesity, diabetes and hypertension, however, the nutritional contents of many donations to these operations fail to meet the dietary recommendations set forth by the USDA for individuals with many chronic health conditions. In the present economy there is increasing demand for the services of local food shelves, however, often these organizations are unable to sufficiently meet the needs of their clients with regard to quantity ,and perhaps more importantly, the nutritional quality and variety of food available. One cause of the lack of nutritionally rich donations is poor public education about the needs of the food shelf and its clients. This study seeks to determine if consumer education at the point of purchase can influence donation decisions to increase the quantity and improve the nutritional quality of items donated to the Chittenden Emergency Food Shelf in a sustainable and reproducible manner.

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  Alcohol Misuse in Elderly Care Facilities

  Martha Choate, Francisco Corbalan, Mei Frankish, Semeret Munie, Jessie Kerr, Jonathan Nucum, Thomas Pace, Thomas Delaney, Wendy Carty, Colleen McLaughlin, and Robert Karp

  Background: While alcohol misuse is largely a problem reported in younger populations, recent studies have shown that it may be a significant, under-reported and under-diagnosed problem in the senior population. Alcohol misuse in this population is further confounded by its association with serious co-morbidities including falls, confusion, and reactions with medications. These problems can be difficult to identify in the aging population, as they may be mistaken for dementia, depression, or other illnesses. Even less studied than alcohol use patterns in the general elderly population are the prevalence and patterns of alcohol use in senior care facilities. In Chittenden County, Vermont, these facilities appear to vary widely in how they identify and assist residents with alcohol misuse issues. Understanding their policies will be an important step towards developing effective strategies for reducing alcohol misuse among residents. The importance of understanding and identifying alcohol-related problems in the elderly is critical as the aging population in this country continues to grow. Proper intervention has the potential to have a real impact; studies have shown that older people have a greater ability to adhere to treatment plans than those in younger age groups, which may contribute to treatment success

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  Nutrition and Exercise Education Initiatives in a Community Setting

  Andrew Erb, Patrick Huffer, Tri Luu, Elizabeth Mebrate, Alyse Rymer, Eleonore Werner, Eric Worthing, Hal Colston, and Halle Sobel

  Introduction: Maintaining a nutritious diet and physical activity is a challenge for many people,but especially for those with limited financial and social resources. Barriers to adequate exercise and healthy food include prohibitive costs of gym membership and high quality foods, lack of time during the day in which to exercise or prepare meals, and lack of access or transportation to exercise facilities or grocery stores. We assessed whether adoption of healthy exercise and eating habits could be established and sustained by educating participants on healthy diet guidelines and on non-traditional exercise forms. We encouraged family-centered activities such as walking, gardening, cleaning, dancing, and playing with children. We quantified changes in participants’ pre- and post-educational diets and exercise habits with 3-day dietary recall logs and pedometer-measured daily steps.

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  Emergency and Scheduled Respite Care for Caregivers of Persons with Dementia: A Model

  Piyush Gupta, Benjamin King, Katherine McBride, Damoon Rejaei, Jennifer Springer, Tyler Stewart, Diana Swett, William Pendlebury, and Linda Martinez

  Background: As the population of elderly citizens in the U.S. continues to expand paralleled by an increase in the prevalence of dementia, the role of respite care within the healthcare system will increase in importance. Respite care is defined as providing the primary caregiver with relief, or a reprieve, from care commitments on a short-term or emergency basis. The need for caregiver respite is well-documented; has been shown to decrease emotional stress,burnout, anxiety and depression; and is considered vital to the overall well-being of the caregiver. While studies have shown that respite care is effective, there is an unmet need for more flexibility in existing programs to improve utilization rates and availability. We attempted to address this issue by adapting an existing model to increase respite care options available to caregivers in our region.

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  Referral Patterns Between Allopathic Physicians and Complementary and Alternative Medicine Practitioners: A Followup Study

  Molly Hubbard, Hany Khattab, Matthew LeComte, Lindsay Peet, Meghan Small, Khine Win, Asha Zimmerman, Margaret Eppstein, Helene Langevin, and Phil Trabulsy

  Introduction: • Despite the high prevalence of Complementary and Alternative Medicine (CAM) usage, several recent surveys suggest that the vast majority of patient visits to CAM practitioners are self-referred and that communication between conventional and CAM practitioners is limited. • There is a need for a better understandingof factors influencing referral patterns across these two groups of practitioners. • Network analysis provides a useful tool to quantify relationships between members of an interrelated social network. • The goal of this follow up study was to quantify the cross-class referral patterns between conventional and CAM classes of practitioners in Chittenden County Vermont as well as gather additional information on the basis of referrals for future studies. • This study was a preliminary examination of possible reasons for the referral patterns.

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  Assessing Health Concerns & Obstacles to Diesel Exposure Reduction in Vermont Diesel Vehicle Operators

  Melissa Marotta, Renee Bratspis, Maria Furman, Brett Porter, Joseph Yared, William Timbers, Quillan Huang, Rebecca Ryan, Gerald S. Davis, and Jan Carney

  Background and Objectives: Diesel vehicle idling reduction is an important national environmental and legislative issue. Exposure to diesel exhaust is associated with significant morbidity and mortality, including: • Lung & esophageal cancer • Asthma • Cardiovascular disease • Neurotoxicity • Decreased sperm count & testosterone deficiency Drivers of diesel vehicles have specifically been shown to have increased incidence and death from lung cancer. Diesel engines emit a number of known hazardous chemicals, including carbon monoxide, nitric oxide, sulfur dioxide, benzene, formaldehyde, and acrolein, into the air supply. While public health efforts to reduce diesel idling in Vermont and elsewhere have identified employers’ significant financial incentives in fuel conservation, perhaps there is also a role for appealing to drivers themselves: the people who are incurring the most direct exposure. It is unknown, however, whether Vermont diesel vehicle operators are aware of the health effects of diesel exhaust – or, more significantly, whether they are concerned about it. In order to identify potential targets for future interventions to reduce diesel idling in Vermont, this study aims to probe the following: • Have Vermont drivers been educated about exhaust exposure? • Are they concerned about potential health effects of diesel? • Are they satisfied with their understanding of the health impact of diesel fuel? • What are their health concerns, more generally? • What resources for health information do they respect? • What are their specific obstacles to idling reduction?

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  Walking For Health: A Community Education and Physical Activity Initiative

  Jessica Andrews, Alycia Horn, Christian Sanchez-Jordan, Amos Shemesh, Jeremy Silver, Tara Song, Katherine Wang, Al Robinson, and Marianne Burke

  Background/Introduction: Vermont was ranked the nation’s healthiest state, according to 2007 America’s Health Rankings. However obesity, currently the second most common cause of death among VT adults, is becoming so common it may replace cigarette smoking as the number one risk factor for death. In fact obesity affects 21% of adults in VT, most commonly low income adults. Obesity is a risk factor for high cholesterol, high blood pressure, heart diseases, and diabetes. Diet quality and physical activity are important factors in preventing obesity. 42% of Vermont adults are below the recommended level of physical activity. Greater knowledge about nutrition correlates with improved diet quality and greater physical activity. A successful educational strategy on physical activity and nutrition promotes group activities and adapts for cultural relevance.

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  How Can I Help You?Eligibility Worker: Navigating Patients Through the Social Services Maze

  Claire Ankuda, Ben Kelmendi, Phillip Lam, Amy Odefey, Mimi Ogawa, Chase Petersen, Emily Schonberg, Jon Bourgo, and Rodger Kessler

  Introduction: Vermont has programs to assist low income individuals in obtaining basic needs such as health insurance, food security, fuel assistance, housing and transportation. However, these services are often underutilized by eligible individuals. Major barriers to enrollment include lack of knowledge about available programs and their income cutoffs, cumbersome application processes, literacy barriers, and lack of transportation to application sites. In other states, efforts to reduce these barriers have included shortened application forms, removal of asset tests, mail-in applications, media outreach, and eligibility workers placed in outreach agencies. Many studies suggest that the presence of an eligibility worker at a community health center can help overcome some social service enrollment barriers.

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  Promoting Physical Activity in Local Communities: Understanding Health, Nutrition, and Physical Activity Needs in Winooski, VT

  Nicholas Aunchman, Anna Bovill, Garret Fidalgo, Oli Francis, Tara Goecks, Sarah Guth, Vandi Ly, Pam Farnham, and Kevin Hatin

  Introduction: Since the Winooski YMCA opened in March 2008, enrollment has been much lower than expected, with only 200 members enrolled by September 2008. One goal of the YMCA is to promote the health of the community by increasing involvement in physical activity in Winooski. Regular exercise is associated with enhanced health and decreased risk of diabetes, cardiovascular disease, as well as many cancers. In order to promote physical activity in the Winooski community, the YMCA set a goal to increase their enrollment to 500 members by December 2008.

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  Warming Climate Changes Vermont Disease

  Elizabeth Baker, Matthew Meyer, Asya Mu’Min, Lindsey Oliver, Daniel Oppenheimer, Steven Perrins, Whitney Young, Razelle Hoffman-Contois, William Bress, and Jan Carney

  Introduction: •The average annual temperature in Vermont has gradual increased roughly 1° Centigrade with an increase of 1.16 inches of annual precipitation over the past 112 years. •According to expert analysis, humans are responsible for 60% of the warming overthe past 140 years. •Projected greater than 1° Centigrade increase in global temperature by 2100 and a correlated rise in precipitation. •Climate changes result in the introduction and reproduction of non-endemic flora and fauna. •Vector-borne diseases accompany warming trends and can become endemic and cause new illnesses in areas which were previously uninhabitable.

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  The Impact of Paid Sick Days on Public Health in an Elementary School Population

  Dino Barhoum, Joanna Conant, David Diller, Annya Fischer, Marisa Hori, Hunter Moore, Kathryn Richard, Colin Robinson, Burton Wilcke, and Jan Carney

  Background: The societal impact of Paid Sick Days (PSDs) has not been fully addressed in Vermont. Evidence suggests that PSDs benefit the well being of the employee in addition to saving expenses for the employer and the state. PSDs prevent the spread of diseases such as influenza and allow the ailing individual to receive proper medical attention. Inadequate PSDs not only affect the individual who needs time away from work due to illness, but extend to their entire family. Studies have documented the adverse effects from lack of PSDs on the ability for parents to care for their child. The following facts are known: • 7 states require private sector employees to provide “flexible” PSDs for family members (Vermont does not). • 66% of employers in Vermont do not provide PSDs for their employees. • Parents with PSDs or vacation are 5.2 times more likely to take time off from work to care for their sick child. We hypothesize that elementary aged children of working parents, who have an insufficient amount of PSDs, are more likely to attend school with an acute illness and are more likely to receive inadequate health care (i.e., miss well child check ups).