Public Health Projects, 2008-present

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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).

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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.