Public Health Projects, 2008-present

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  Public Perceptions of Smoking in the Workplace

  Jessica Barry, Jennifer Kneppar, Timothy Salib, Jonathan Severy, Bennett Shapiro, Kathryn Skelly, Kara Tweadey, Rebecca Ryan, and Gerald Davis

  Introduction: Important public health policy decisions must be based on reliable epidemiologic studies and evidence-based medicine. In the effort to ban smoking in the workplace, there must be clear evidence from the constituency that such laws are desired. Current Vermont law states: "Employers may designate up to 30 percent of an employee cafeteria or lounge as a smoking area and may permit smoking in designated unenclosed areas only if … smoking will not be a physical irritant to any non-smoking employee, and 75 percent of the employees in the designated areas agree to allow smoking." State legislators must address this issue for several reasons: * Long term effects including lung cancer, emphysema, heart and neurologic disease. * Secondhand smoke contains at least 250 chemicals known to be toxic, including more than 50 that can cause cancer. * The total cost of secondhand smoke exposure in the U.S. at $10 billion annually, $5 billion in direct medical costs, and $5 billion in indirect costs such as lost productivity. * Methods to reduce the effect of secondhand smoke, such as ventilators are ineffective. * One study found a 17% increased risk of developing lung cancer with smoking exposure in the workplace. Regardless, Vermonters continue to smoke; as of 2007, 18% of Vermont’s adults were smokers. Such information is important in making legislative decisions that affect the entire Vermont population

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  Suburban Satellite Health Care Facilities Limit Access for Low-Income Patients

  Angus Beal, Hannah Caulfield, Elizabeth Cipolla, Theodore Elsaesser, Andrew Gagnon, Megan Gossling, Yangseon Park, Jill Jemison, Annika Hawkins, and Mary Anne Kohn

  Introduction: Low income individuals are faced with numerous barriers to health care that can lead to worse health outcomes. Limited access to transportation, in particular, has been linked to lower rates of doctor’s visits and consequently, a greater burden of disease. Community agencies such as Safe Harbor (SH), the Community Health Center (CHC), and the Committee on Temporary Shelter (COTS) in Burlington, Vermont reported the move of many ambulatory care practices from Fletcher Allen Hospital, located on a citywide bus route, to Tilley Drive, which was not located on a bus route, as a significant barrier for their patients.

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  Identifying Best Practices Among Lay Health Educators

  Erin Beardsworth, Kelsey Davidson, Andrew Fanous, Rebecca Gordon, Brian Kilonzo, Isaac Leader, Jason Shen, Tania Bertsch, and Debbie Dameron

  Background: The utilization of mammography has been shown to be lower in socioeconomically disadvantaged groups, which includes the African refugee community in Vermont. Mailed letters, telephone reminders, and massive media campaigns have proved ineffective at increasing rates of mammography screening in socioeconomically disadvantaged populations. However, a promising method to increase mammography screening is the use of peer educators to conduct home visits or group educational sessions. The Association of Africans Living in Vermont (AALV) has trained peer educators from the African community, known as Lay Health Educators (LHEs), to help increase mammography screening in this population.

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  Health and Housing in an Aging Population: Identifying Risk Factors of Seniors Living Independently

  Rachel Bell, Francois Coutu, Robert Johnston, Brendan Kelley, Shailen Mhapsekar, Jane Roberts, Heather Viani, Jennifer Hunter, Tom Delaney, and Patricia Berry

  Background: Aging is associated with numerous risk factors for declining physical and mental health. As a result, many elder individuals are forced to relocate to nursing homes, assisted living centers or just closer to adequate medical facilities. Studies have shown: • Relocation of elders is associated with depression, anxiety, memory loss, and decreased social adjustment and life satisfaction • Persistently lonely people exhibit a 2-fold greater risk for developing Alzheimer’s disease (AD) than those who are not chronically lonely • Increased social interaction improves cognitive function in individuals with AD By helping seniors to age in place, many of the deleterious risks of relocation, such as social isolation, depression, and cognitive decline could be avoided. In addition to relocation, other risk factors that affect cognition have been identified: • Physical activity is associated with higher cognitive functioning in elders • Polypharmacy is a risk factor for impaired cognition Thus, simple modifications that allow seniors to age in place may reduce morbidity and enhance quality of life. Cathedral Square Corporation (CSC) is a non-profit organization whose mission is to develop, manage, and own housing that provides community services to promote the health and well-being of elders, low income persons, and persons with disabilities. Students from the University of Vermont College of Medicine (UVM) partnered with CSC in a project to promote aging in place via evaluation of seniors’ current needs and the development of a service model to meet these needs at home.

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  Organic Produce: Consumer Perceptions and Practices

  Aaron Bos, Lawrence Dagrossa, Rachel McEntee, David Morrow, Erin Perko, Anthony Vu, Jennifer Wlodarski, Caroline Homan, and Robert Luby

  Background: Organic food is the fastest growing sector of the U.S. food market. It is a common belief that organic food is healthier and more environmentally friendly when compared to food grown and processed conventionally. Despite presumed benefits, our objective was to answer the following questions: • Why do consumers choose organic, especially when faced with a higher average price? • Is there scientific evidence that organic foods are healthier than their conventional counterparts? This project built on a previously conducted demographic and shopping habits survey by our partner agency, City Market, of Burlington, VT.

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  The Effects of Text Message Reminder on Blood Donor Show Rate

  Benjamin Briggs, Alan Frascoia, Vadim Petrov-Kondratov, Shayna Rivard, Phan Thai, Lauren Wendell, Matthew Williams, Carol Dembeck, Peter Nattress, R Wilson, Mark K. Fung, and Jan Carney

  Introduction: Declining blood collection endangers the blood supply at a time when the health care system is requiring an increasingly greater amount of blood products. Blood donation centers are challenged to recruit and develop first-time donors into reliable repeat donors, thereby ensuring a sufficient blood supply. Communication strategies such as e-mail reminders have been shown to be an effective communications tool to promote blood collection. Alternatively, Text Messaging has been shown effective in primary care and preventative medicine. Text messaging improved patient compliance with a schedule of vaccine dosing, as well as improving patient attendance at outpatient clinics. Additionally, text messaging reminders have been shown to be as effective as phone reminders in increasing patient attendance at outpatient appointments. Finally, text messaging has been shown to be useful for managing self-care such as smoking cessation, monitoring asthmatic symptoms, and diabetes control. We investigated whether offering the use a text message reminder to donors would increase attendance at donation events, demonstrating that text messaging can be an effective tool in maintaining a pool of blood donors.

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  What You Don’t Know Can Hurt You: Communicating Health Law with Vermont Physicians

  Theresa Duong, Andrew Eyre, Ari Garber, Abby Gross, Melissa Hayden, Joshua Kohtz, Julie Lange, William Wargo, Virginia Hood, and Jan Carney

  Background: Physicians today need a working knowledge of pertinent medical law. With an increased focus on patients’ rights in health care, states are encouraged to set specific laws protecting patients. The additional medical legislation places a challenge on physicians to continually update their medical-legal acumen such as disease reporting, malpractice issues, and medical information access.Little research has been conducted on physicians’ knowledge of the law and medicine. In an effort to expand upon these topics and to find an efficient way to make information about the law and medicine accessible to Vermont physicians, the University of Vermont College of Medicine partnered with the Vermont Board of Medical Practice to answer the following questions: • How well do Vermont physicians understand laws that relate to the practice of medicine? • How do Vermont physicians access nformation on law and medicine? • What topics are most relevant and important to Vermont physicians? • What educational methods willbe effective and how can the Vermont Board of Medial Practice best serve such education needs?

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  Referral Patterns Between Allopathic Physicians and Complementary and Alternative Medicine Practitioners

  Dan Gale, Shohei Ikoma, Quinn Meisinger, Caroline Moats, Jessica Sayre, Marvin Scott, Susan Varga, Mimi Reardon, Helene Langevin, Margaret Eppstein, and Robert Davis

  Introduction and Objectives: The provision of basic healthcare in the United States may be viewed considering two different, and sometimes combined, therapeutic approaches: •Allopathic/osteopathic medicine •Complementary and alternative medicine (CAM) Our study is interested in the intersection of allopathic medicine and CAM. Evidence suggests that Americans are seeking CAM at a similar or even a higher rate than allopathic medicine, yet there seems to be a division between practitioners of each discipline. Isthis division created by a lack of coordination, such as an inadequately established referral system, or by a general lack of knowledge, or by the attitudes of the practitioners? In our study our objectives were: ? To assess the referral patterns between allopathic and CAM practitioners in Chittenden County. ? To examine the various factors that may influence these referral patterns using confidential surveys.

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  What is the Value of Group Nutrition Education for Older Adults with Diabetes?

  Patrick Hackett, Elizabeth Lagana, Metasebia Munie, Sinan Ozgur, Heather Provencher, AmiLyn Taplin, James Ware, Sarah Russell, and Amanda Kennedy

  Background: • 23.6 million people or 7.8% of the US population have diabetes • Type 2 diabetes can cause many serious problems that affect the heart, nerves, eyes, and kidneys • Lifestyle choices, including dietmanagement, can be used to control or help supplement medical care used in minimizing the risk factors associated with diabetes

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  Neighborkeepers: Buddies for Better HealthAn Intervention to Improve Physical Activity Habits

  Aaron Kraut, Barron Reyes, Catherine Mygatt, Tim LeClair, Sarah Gillett, Molly Wasserman, Hal Colston, Karin Brenin, and Karen Richardson-Nassif

  Introduction: associated health complications have increased steadily across the United States. As a result, physical activity considerations have become a more significant focus of healthcare providers and government agencies. Recent studies suggest that social support network approaches, such as the "buddy-system," improve participant adherence to physical activity regimens. To improve physical activity frequency and adherence, we implemented a buddy system approach with participants involved in a community outreach organization.

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  Self-Empowerment Within the Woodside Juvenile Rehabilitation Center Population

  Joseph Platz, Elizabeth Crowley, Adham Zayed, Matthew Lynch, Mary Guillot, Hugo Valencia, Jessica Alsofrom, Alan Rubin, and Judith Christensen

  Abstract: Intro Teens at the Woodside Juvenile Rehabilitation Center struggled with personal health and self-empowerment in the health care setting. Methods We spoke with both detention and treatment residents about their health. We constructed self-health surveys which were completed by 16 residents. Analysis of the results led to creation a self-health advocacy and activity booklet to be completed by current and future residents. Results Residents had health coverage but only sought dental care, feeling little control over doctor visits. Stress stemmed from family and friends and was coped with via exercise. Interest in learning about relaxation and long term health was expressed. Discussion Health information needed to be incorporated into patient-interactive teaching methods and self-analysis, focused on self-reflection and changing attitudes rather than raw health knowledge.

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  Barriers to Pediatric Blood Lead Screening

  Amanda Abramson, Catherine Avener, Jillian Brennan, Elizabeth Hill, Britton Keeshan, Jeffrey MacLean, Kelly Mebust, Sanchit Maruti, Wendy Davis, Austin Sumner, and Jan Carney

  Background: The pernicious effects of lead on the health of children are well-documented. The severity of many of these effects directly correlates with increasing blood lead levels (BLLs). The current recommendation from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) is that BLLs 10 g/dL are dangerous. However, new evidence demonstrates that there is no safe BLL and that children with BLLs /dL exhibit neurological and social deficits. The Vermont Department of Health (VDH) currently recommends universal blood lead screening for 12 and 24 month-old children. In 2006, 79% of 12 month-old children and 41% of 24 month-old children were screened in Vermont.

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  Health Literacy and Medication Practices in Senior Housing Residents

  M. Alavian, J. Cassavaugh, S. Haji, J. Hellmuth, M. Homes, S. Mulligan, A. Old, A. Whitehead, K. Fitzgerald, A. Kennedy, V. Hood, and J. Carney

  Objective: To conduct a descriptive analysis of health literacy, knowledge of prescribed medications, and methods of administering medications in a cohort of senior housing residents.

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  Enhancing Attendance of the Greater Burlington YMCA Diabetes Fitness Program

  Nicholas Antell, Michelle Cangiano, Jessica Deane, Chris Lin, Rebecca Martin, Sarah Schlein, Richard Zinke, Pam Farnham, and Kevin Hatin

  Introduction: Since 1999, the Burlington YMCA has offered a free aerobics class to members of the community with diabetes. Additionally, the class regularly monitors participants’ health status. These data support the well-established benefit of exercise in diabetes. Medical Monitoring •hemoglobin A1C •blood pressure •resting pulse rate (before and after each twelve week session) About the Program •Began in 1999 •Free •Physician’s referral required •2h aerobics, twice per week: 1h land + 1h water

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  Factors Affecting the Nutritional Status of Chittenden Emergency Food Shelf Clients

  Dilip Babu, Jessica Bordley, Luz Felix-Marquez, Kara Gaston, Jason Halperin, Elise Heath, Anna Liberatore, and Lynn Zanardi Blevins

  Objectives: Using a twenty-four hour food recall and the USDA MyPyramid guidelines, we considered how various factors affect the nutritional status of Chittenden Emergency Food Shelf clients. The factors we considered were housing stability, body mass index, sharing of food with dependants, skipping meals, and enrollment in the Food Stamp Program. The results of our study will inform the Food Shelf about their clients and the barriers they face in trying to maintain a healthy diet and potentially be used to improve programs.

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  Health Coverage History of Local Uninsured PatientsAssessing the Need for an Eligibility Specialist

  C J. Bailey, L P. Gerety, MH Guignon, A. S. Helminski, AA Merriam, J. Ravera, A Tang, W. G. Tharp, J Bourgo, and H Maltby

  Abstract: Uninsured Americans are a growing population as insurance premiums climb and fewer employers offer health coverage. Providing medical care to the uninsured often represents a significant financial loss to medical institutions. Our study sought to describe the insurance history and barriers to obtaining health coverage for uninsured patients at the Community Health Center of Burlington, Vermont (CHCB). The potential benefit of adding an insurance eligibility position to the staff at CHCB was also explored. Data were collected by random phone survey from 100 CHCB patients identified as uninsured at their last visit; patients were queried regarding insurance history and interest in enrollment assistance. At the time of survey 66% were currently uninsured, and the majority (87.9%) of these respondents previously held insurance. Loss of insurance was most often due to a change in job status, income or a change in eligibility. Cost was a major barrier to insurance noted by individuals; on average respondents indicated they would be willing to pay around $65 per month for overage. A majority (75.7%) of uninsured respondents also expressed interest in an onsite eligibility worker. These data suggest that the patient population at CHCB would be well served by implementing some form of eligibility staffing. There are a number of different health insurance options in Vermont that could benefit these patients, provided they have assistance with applying. Due to the small sample size of our survey, we recommend that the scope of the eligibility position be determined by closely examining the caseload encountered.

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  Smoking Profile of Woodside Juvenile Detention Center and Interventional Goal-Setting Workshop

  Stephanie Bakaysa, Daniel Goold, Meghan Gunn, Cortney Haynes, Jeffrey Kaye, Ryan Vealy, Yana Wirengard, Hijab Zubairi, Judith Christensen, and Jan Carney

  Abstract: We studied smoking status among teenage residents at the Woodside Juvenile Rehabilitation Center (Woodside) in Vermont. Using a modified CDC survey and focus groups, we found that short-term detention residents (S group) were significantly more likely to be “smokers” than the long-term treatment residents (L group). All residents reported that stress had an important impact on their lives. Based on our findings, we implemented a goal setting workshop for both L and S groups.

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  A Survey of Motivations for 9/11, Hurricane Katrina and General Lapsed Donors in Northern Vermont

  G Balderama, P. Chen, M. Clay, S. Dorsky, C. McIlree, J. Sisemoore, J. Stinnett-Donnelly, C. Dembeck, P. Nattress, J. Carney, and M.K. Fung

  Introduction: Despite rising demand, blood donation has remained stagnant in recent years, except for donation spikes that occurred in periods after major national crises such as the September 11th attacks in 2001 and Hurricane Katrina in August 2005. During times between such events, the majority of blood donations are due to repeat donors. The remainder of the blood supply is supplemented by one time or infrequent donors who have since stopped giving blood, i.e. lapsed donors. A third group of donors, designated disaster donors has been identified. These are individuals who donated blood due to these disasters but who have since stopped giving blood. A vast body of information exists on the motivating factors that bring people to donate and the barriers that prevent them from coming back. For the purposes of this study, three groups of lapsed blood donors were identified. A survey was conducted to investigate the perception these donors have of the current blood supply, motivating factors for their past donations, and their opinions on potential ways to bring them back as consistent repeat donors.

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  Barriers to Health Literacy and Competency Participatory Education in the Champlain Valley Head Start Program

  Alyssa Bennett, Kenneth Christian, Rosamund Davis, Vanessa Hui, Jessie Janowski, Elizabeth Lycett, Christopher Randall, Michael Salmela, Melissa Barrett, and Christa Zehle

  Background: Poor health literacy has impeded public health efforts for many years. Several barriers to achieving higher levels of health literacy have been identified and specific ethods to overcome these have been applied: • Role-playing has been shown to be an effective way to communicate ideas, creating audience participation and learner empowerment. • Pictographs, simple drawings depicting stories or principles, have also been used to make health information more comprehendible. • Non-written forms of communication have been especially useful in overcoming language barriers. • A recent Harvard study demonstrated the ability to increase health literacy in low-income populations. Over a three-year period, educational posters and pamphlets were placed in primary care offices throughout Massachusetts. Assessment surveys were mailed to participants before and after the trial. An increase in health competency was most significant in low-income populations. These studies formed the foundation for our current work, which sought to improve health literacy among parents of the Chittenden County Head Start Program. This is a nationally-funded program dedicated to providing free, comprehensive health, nutrition, and social services to families with pre-school children (ages three to five). Participants in the Head Start Program must have low-income to be eligible.

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  Access to Health Care Through Catamount Health; Do Providers Know Enough to Refer?

  Morgan Carlson, Lisa Chui, Walter DeNino, Neel Kapasi, Amy McGettrick, Adrienne Pahl, Trevor Pour, Heidi Schumacher, Serena Choudhry, and Burton Wilcke

  Background: On November 1, 2007, Vermont launched ‘Catamount Health,’ a state-sponsored private insurance plan. The goal: to close the gap between privately insured and Medicaid insured Vermonters. Previous programs such as Dr. Dynasaur and VHAP were already in place to care for children and low-income residents respectively. Now, under the umbrella title of “Green Mountain Care,” Catamount Health joins them. Catamount Health offers private coverage through either Blue Cross/Blue Shield of VT or MVP Health Care, the cost of which is offset by the state according to income level and household size. To qualify for Catamount, an individual must have an income of at least $1,277 (lower incomes qualify for VHAP), and meet a number of criteria: • Vermont residents 18 years or older • Not currently eligible for other state-sponsored health insurance programs • Have been living without health insurance for 12 months or more unless insurance was lost due to: - Loss of employment - Divorce from or death of a spouse/partner - Dis-enrollment from college or your parent’s plan - No longer eligible for Medicaid or VHAP - No longer have COBRA coverage • Do not have access to insurance through employer The estimate of uninsured Vermonters is 65,000, or 10% of the state population (National rate: 15.7%). 73% of all uninsured residents are between the ages of 18-49, which has been cited as the target population for Catamount. The State of Vermont has budgeted close to $1.6 million dollars to fund a large-scale advertising campaign on television, radio, newspaper, and on foot. Following this campaign, there is a high likelihood that Vermonters will bring questions and concerns about Catamount to their physician offices and community leaders, emphasizing the importance of a well-educated provider.

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  Defining a Paradigm for the Dissemination of Health Information to Immigrant Populations at the Fletcher Free Library

  Kristen Connolly, John DeWitt, Juli Gardner, Joseph Lopreiato, Leah Novinger, Timothy Plante, Uni Wong, Amber Gaster, Mark Pasanen, and Jill Jemison

  Abstract: In recent years, the surge of refugee families to the greater Burlington area has lead to a significant increase in the minority population of the city. The Fletcher Free Library (FFL) represents a potential health information resource for this population; it is, however, little utilized. Our project sought to target one of these minority populations, the Somali Bantu, and to diminish the barriers to the use of the FFL’s resources within the Somali population itself. To reduce barriers to access of health information by the Somali Bantu population, we educated the FFl’s reference librarians on Somali culture, developed a compendium of health information in both English and Somali for inclusion within the library’s collection, and staged a one-day intervention at the Community Health Center of Burlington to present the FFL as a potential source of health information for refugee populations. Somali Bantu use of the library, as well as reference librarian confidence in serving this minority population,was objectively assessed via pre- and post-interventional surveys.

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  Respiratory Management of Patients with ALS in Northern New England

  Katie Davisson, Ariel Gallant-Bernstien, Mai Hoang, David Longstroth, Bryan Mason, Colleen Moran, Omar Ozgur, Abigail Woodhead, Rup Tandan, and Christine Broderick

  Background: • Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease caused by the degeneration of brain and spinal cord motor neurons, leading to steady loss of voluntary muscle function and early death from respiratory failure. •The incidence of ALS is 1?2/100,000 population, the prevalence is 5?6/100,000 and approximately 30,000 people are living with ALS in the United States. • Currently there is no cure for ALS; treatment is focused on symptomatic care and improving the quality of life. • Most ALS patients in the United States are treated either at multidisciplinary ALS centers/clinics in academic institutions or by community?based physicians/ neurology practices. • It is unclear if outcomes in patients with ALS are different among those followed in multidisciplinary clinics(MDC) versus community based physicians/ neurology practices (CP). • The goal of this project was to compare the type of respiratory education and care received by patients with ALS from Northern New England at MDC’s (Fletcher Allen and Dartmouth Medical Center) versus CP.

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  Hypertension Education and the Burlington Housing Authority

  Rebecca Evans, Matt Greene, David Iberri, Casey Johnson, Benjamin Kunz, Annice Mason, Kanayo Tatsumi, Kelsey Walton, Sarah Russell, Alan Rubin, and Jan Carney

  Background: • 2/3 seniors are hypertensive (>140/90 mm Hg) • Hypertension is the most common risk factor for premature heart disease and stroke • Non-modifiable risk factors: race, age, sex, diabetes mellitus, and hypercholesterolemia • Modifiable risk factors: smoking, obesity, and excessive alcohol • Clinical trials show that lifestylemodification and medications can reduce the incidence of adverse outcomes associated with hypertension • Patient education is a high priority

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  Barriers to Completing Colonoscopy Screenings

  Adetola Fadeyibi, John Fialkovich, Mellory Gibberson, Joseph Kaserman, Peter Lloyd, Melinda Myzak, Joseph Pare, Greta Spottswood, Debbie Dameron, and James Vecchio

  Background: - Colon cancer is the second leading cause of cancer death in the United States and the third leading cause of cancer death in Vermont. - Colon cancer progression may be prevented by removing precancerous polyps found on colonoscopy screening. -Vermont ranks among the states with the best colon cancer screening rates, but there is room for improvement. In 2006, 55.5% of Vermonters over 50 years of age had undergone a sigmoidoscopy or colonoscopy within the last 5 years. Vermont’s public health goal is to raise this percentage of screened individuals to 65% by 2010. - Vermont medical institutions have the resources to perform screening colonoscopies on all Vermonters over 50 years of age. - Although primary care physician (PCP) recommendations increase the likelihood of a patient completing a colonoscopy screening, a substantial number of patients referred for screening colonoscopies do not complete their appointments.

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  Chittenden County Child Care Providers & Conflict Implementing Sick Child Guidelines

  Shahin Foroutan, Joanna Gell, Hui-Shan Hsu, Elena V. Simon, Justin Smith, Kirsten Threlkeld, Nicholas Weinberg, Meghan Flanders, and Jillian Sullivan

  Introduction: Nationwide, 61% of children under age five are enrolled in a form of non-parental care. Problems arise when a child becomes sick and is not able toattend daycare or has to be sent home. Parents must either miss work to care for their child or find someone else to care for them. Since there is stress surrounding taking time off, and because the criteria used to exclude children from child care can be ambiguous, parents may feel that their child doesn’t need to be sent home. Each child care provider has to set up exclusion criteria that meet state licensing requirements. The American Academy of Pediatrics (AAP) developed exclusion guidelines specifically for childcare settings in 2006, but most daycare providers and pediatricians are unaware of its existence. Conflicts occur when there are differences in opinion on the child’s health status between the child care provider and the parents or the child’s pediatrician.