Gaps in Adolescent Tobacco Prevention and Counseling in Vermont

Introduction. Tobacco use remains the leading cause of preventable death in Vermont. While the Vermont Blueprint for Health includes compensation for adult tobacco counseling, it includes no specific mention of pediatric populations. Research questions: To what extent are tobacco assessment and cessation efforts occurring in the primary care setting with pediatric patients? What factors influence their practices?Methods. A 12-question electronic survey, modeled on an American Academy of Pediatrics survey, was distributed to primary care providers throughout Vermont; through the UVM departments of pediatrics, family medicine, the Vermont Medical Society and the Vermont Area Health Education Center. We received 70 completed surveys.Results. 70% of the surveyed primary care providers begin tobacco counseling at the age recommended (11 years) by the Vermont Department of Health. Only 45.71% of providers are confident in their understanding of the recommendations for adolescent health screening written in the Blueprint for Health. Additionally, only 67.1% of the providers expressed confidence in their ability to provide guidance regarding the harmful effects of E-cigarettes, compared to 92.8% feeling confident regarding conventional cigarettes. 70% of providers listed time restraints as a significant factor in their decision not to counsel adolescents on tobacco use.Discussion. The Blueprint for Health is a guiding document for provider practices that is not well understood and does not specifically include pediatric tobacco prevention. In an environment where youth E-cigarette use is rising, especially among adolescents, it is especially critical that physicians are confident in their counseling practices.https://scholarworks.uvm.edu/comphp_gallery/1237/thumbnail.jp

Living in Recovery:Perceptions of Health Care and Comorbidities in Rural New England

Introduction: Alcohol and Drug Abuse: In the USA, abuse of tobacco, alcohol, and illicit drugs is costly, exacting more than $700 billion annually in costs related to crime, lost work productivity, and health care. 9% of Vermont residents and 8% of US residents report alcohol or illicit drug abuse, and 10% of US adults consider themselves to be in recovery from drugs or alcohol. Health Care and Recovery: Persons with drug addictions are approximately twice as likely to suffer from mood and anxiety disorders compared to the general population. Aside from mental health disorders, other common comorbidities include dental problems, insomnia, and migraines. The majority of people in recovery report having a primary care physician, but they receive fewer preventative health care interventions compared to the general population. The Turning Point Center of Chittenden County: The Turning Point Center is a non-profit organization that provides a safe, substance-free environment and peer-to-peer recovery activities to assist in recovery from addiction.https://scholarworks.uvm.edu/comphp_gallery/1231/thumbnail.jp

Needs Assessment of Suicide Prevention in Vermont Middle and High Schools

Introduction. Adolescent suicide is epidemic. 17% of high school students con- sidered suicide and 8% attempting to take their lives in 2015 nationwide. Vermont has seen a 2% increase within the last two years according to the VT Youth Risk Behavior Survey. School is one of several settings where effective suicide interventions could take place. Previous studies have identified means prevention as an effective way to combat adolescent suicide. This study aims to identify training levels and comfort of school staff in dealing with suicidality. Methods. A survey was emailed to all schools in Vermont covering grades 6-12. The survey addressed employee demographics, training, perception of suicide in their school, and concern regarding lethal means. Questions were multiple choice, scaled and free responses. Data was analyzed using SPSS and free responses were organized using thematic content analysis. Results. 126 responses represented 46% of Vermont middle and high schools. 77% agreed or strongly agreed that they felt confident in recognizing a student with suicidality. Respondents were not comfortable implementing lethal means prevention. Respondents identified early intervention and trusting communicative relationships as key to prevention, and identified lack of time, protocols, and resources as obstacles. Discussion. Respondents identified suicidality in 2.2% of their students, com- pared to the YRBS that recognized 12% of adolescents. Survey technique may con- tribute to this discrepancy, but it is also likely that schools are failing to identify students at risk. A lack of comfort recognizing suicidality and implementing prevention techniques warrants standardized training, screening and response protocols.https://scholarworks.uvm.edu/comphp_gallery/1265/thumbnail.jp

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

Introduction: Committee On Temporary Shelter (COTS) is a community organization that provides gateway housing opportunities to fourteen previously homeless veterans through its Canal Street program in Winooski, VT. Many of the residents struggle with physical fitness, poor nutrition, and mental illness, including PTSD. Research has shown that there is an increasing prevalence of overweight or obese veterans returning from service, and these individuals present a particular challenge to primary care physicians as their mental health issues are closely related to their level of fitness. It has been demonstrated that veterans often suffer from ingrained food insecurity, which negatively influences post-service eating behavior, and readjustment solutions are needed to ease reentry into civilian life. While literature recommendations exist outlining the important role of initiating easy-to-use exercise programs and the beneficial impact of exercise in a natural environment on veterans, there has been little research into more holistic approaches to improve the diminished quality of life impacting many individuals with PTSD. Recent literature shows decreased PTSD symptoms after a life skills intervention and that short-term nutritional education interventions have the capacity to favorably change eating behaviors in a low income population. Therefore, we decided that a comprehensive, yet personalized intervention was needed.https://scholarworks.uvm.edu/comphp_gallery/1211/thumbnail.jp

Assessing Barriers to Community Pediatric Dental Needs

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.https://scholarworks.uvm.edu/comphp_gallery/1060/thumbnail.jp

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

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.https://scholarworks.uvm.edu/comphp_gallery/1043/thumbnail.jp

Legislator Beliefs, Perceptions, and Voting Influences regarding Carbon Pricing: Implications for Climate Change and Health Advocacy

Carbon pricing was proposed to reduce carbon emissions which has been linked with negative health effects such as: • Increased incidence of heat stroke • Food poisoning • Malnutrition via food shortages • Vector-borne illnesses • Asthma • Allergies Purpose: To understand factors that affect legislators’ carbon pricing voting, guiding future health educators and advocates.https://scholarworks.uvm.edu/comphp_gallery/1282/thumbnail.jp

Assessing Health Needs of the Burlington Probation and Parole Population

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 communityhttps://scholarworks.uvm.edu/comphp_gallery/1068/thumbnail.jp

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

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.https://scholarworks.uvm.edu/comphp_gallery/1022/thumbnail.jp

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

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.https://scholarworks.uvm.edu/comphp_gallery/1016/thumbnail.jp