Summer 2020 MPH Public Health Practice Experience projects

Breana Turner’s experience involved evaluating Girls on the Run of Northern Virginia’s FY21 strategic goals. Girls on the Run of Northern Virginia is an afterschool program for girls in third through eighth grades to participate in a running program. Girls on the Run seeks to decrease the disparities in physical activity between youth boys and girls by creating a safe, equal, and fun opportunity for girls to exercise after school. However, Girls on the Run is more than “just” a running program, and their curriculum serves to empower young women through exercises and activities about self-esteem and confidence, ultimately providing girls with the confidence to have agency over their own bodies and decisions. 

Breana had three major objectives. The first objective was to devise a plan for stakeholder engagement, including coaches. Objective two was to follow the strategic plan, evaluate program survey data, and make observations and recommendations for program improvement. Third was to design an outreach strategy to target and increase participation of girls in lower-income areas. 

To address her first objective, Breana collaborated with Girls on the Run employees to create promotional and interactive material to populate the interactive coach community pages. She used various quotes and calls to action as well as provided health communication information in the Facebook groups.

For objective two, Breana evaluated two seasons’ worth of qualitative data to discuss the successes and challenges of each season, which she compared to the internal FY21 strategic plan. She provided the rationale and recommendations in a report to the Girls on the Run team. 

For objective three, she researched nontraditional sites for Girls on the Run teams to take place, such as apartment complexes, recreational centers, and community centers. This increased Girls on the Run’s scope of influence and broke down barriers for girls who might not have access to transportation or even the funds to be in the afterschool program on the school grounds. It also assisted with COVID-19 contingency plans, as many of the schools in northern Virginia were not meeting in person at that time. 

Conclusions and outcomes: 

For objective one, Breana used the online editor Canva and worked closely with the volunteer recruitment liaison to create interactive materials. The flyers and communications increased the participation and overall communal feel of the Facebook group. One of Breana’s deliverables highlighted the COVID-19 Virginia reopening plan, and she also created a flyer for the testing that was taking place in northern Virginia. 

Objective two was satisfied through the spreadsheet that she presented to the Girls on the Run team at the conclusion of her internship experience. This Excel spreadsheet picked up themes that occurred throughout the seasons of Girls on the Run. She provided different solutions to overcome those challenges and barriers as well as the rationale for why this was needed, using the FY21 goals to support. One of the challenges that some of the girls faced was improper access to equipment and running items. Breana provided the rationale to get over that hump. In the broader spreadsheet, she laid out the FY21 goal that it satisfied as well as supporting evidence for those recommendations. 

For objective three, Breana researched and provided a list of community centers, private schools, and other recreational centers that could serve as possible sites for Girls on the Run teams. At the conclusion of her internship, the group added 19 new sites, an amazing accomplishment given the current pandemic. 

Breana felt that this was a valuable learning experience. Given the nature of her virtual internship, she learned that it’s important to use time wisely during Zoom calls. Breana also stated that evaluating the impact of the program and reading comments associated with surveys provided a larger scope for her to understand the overall impact of the program. Breana revealed that she knows firsthand that self-confidence impacts health outcomes and health equity, and she feels that it’s awesome that Girls on the Run in Northern Virginia (and Girls on the Run as a whole) provides a translational approach to improving the future health outcomes for women.

Thomas Ragsdale’s poster was entitled Revising CHIP’s Family Planning Assessment. CHIP is the Child Health Investment Partnership of Roanoke Valley, and their mission is to serve pregnant moms, low-income children, and their guardians by helping them access medical services, manage chronic conditions, and by assisting with developmental education, kindergarten preparation, and child assessment and monitoring. CHIP wanted to review the usefulness of the family planning, prenatal experience, and safe sleep assessments that their staff use with the families they serve. 

Thomas partnered with another MPH student to interview the CHIP nurses and case managers to understand their attitudes about these three assessments and to see how user friendly the assessments were for staff. In total, they interviewed 14 out of the 16 nurses and case managers. Two of them were not able to interview because of scheduling conflicts. Thomas and his partner conducted the interviews over Zoom, recorded and transcribed the interviews, and then wrote up a summary report, which they provided to CHIP. 

Based on their interviews with CHIP staff, the following themes emerged regarding the family planning assessment. First of all, the form needed more logical flow controls. For example, if the parent or guardian of the child had already been sterilized, then the family planning assessment should logically skip over the questions about contraception. However, Thomas found that the current form was lacking the controls to skip those questions. 

Thomas and his partner also heard from the staff interviewed that some of the questions had only yes and no as possible options, which staff found limiting in certain scenarios. There were questions where more detailed information would have helped staff know how to best deliver the education and also would have helped with data collection for research purposes. 

The staff reported that the assessment was great for guiding conversation but sometimes felt too much like a quiz that someone would receive in school. There were also themes that emerged regarding the prenatal experience and safe sleep assessments, which were two assessments that the team did not end up revising. Those themes were mostly centered around the fact that the staff needed more resources about referring patients for bassinets, needed more culturally diverse and low-literacy resources, needed help facing the unique challenges posed by the COVID-19 pandemic, and wanted more training on asthma protocols and related issues. 

After Thomas and his partner completed their interviews with the CHIP staff and wrote up their report, they focused on revising the family planning assessment. They chose this one to revise, as it was the one that seemed to require the most revision and was also the one that CHIP wanted them to revise the most. 

They adjusted the assessment to be used not only for mothers but also for guardians who might not necessarily be the child’s mother, to include male partners or custodial grandparents. They additionally expanded the assessment to include information about STI history, female examinations, and contraceptive use and intent. 

The assessment that CHIP was using previously was fairly short and bare bones. While it was good for planning the education and program delivery for CHIP staff, it didn’t seem to be the best for collecting data to be used for research purposes or even for program evaluation. The new assessment that Thomas and his partner developed was a bit better organized, and they added color to make it stand out visually. They added logical control statements in the questions to make the assessment more user friendly and easier for the CHIP staff and the parents and guardians to complete without having to answer unnecessary questions. 

In the birth control use section, the team added contraceptive intent questions, which they obtained from a published study in their literature review, that ask how important it is for the patient ot use birth control right now and whether the person they have sex with is for or against them using birth control. They also included different questions about the client’s social and sexual and STI/STD history. They added a space for staff to write additional free-form notes for information that might not be asked on the form but that they still feel is relevant. This was something that was requested frequently in their interviews with the CHIP staff.

Emily Hoyt’s PHPE was to develop a policy recommendation for the Joint Subcommittee for Health and Human Resources. In 1965, Congress developed the Older Americans Act in response to a concern about a lack of community services for older adults. This also established State Units on Aging, which required states to designate an agency to plan, develop, and administer state aging activities. In Virginia, that agency is the Virginia Department for Aging and Rehabilitative Services (DARS). 

In 2020, the Virginia General Assembly developed legislation which tasked the Joint Subcommittee for Health and Human Resources with investigating the validity of moving the Office for Aging Services (OAS) to the Department of Social Services (DSS). Emily’s objective was to create a policy recommendation based on her research questions for the Joint Subcommittee for Health and Human Resources on a potential restructuring of the Virginia Office for Aging Services. Her research questions included the benefits of the 2012 VDA DRS merger, the intersections between aging and disability programs, the structure of State Units on Aging across the US, and also the impacts of moving the Office for Aging Services to DSS. 

Emily’s first research question was, “Does the merger enhance communication between agencies that already have a long history of collaboration and overlap between clients and program?” This streamlined access to services for older adults and those with disabilities. It enhanced the important intersection of aging and disabilities supports that already existed and also increased coordination of these supports while allowing for collaboration on Chronic Disease Self-Management Education and Falls Prevention grants and others. 

The intersection between aging and disability programs currently includes overlap between the Centers for Independent Living and No Wrong Door as well as brain injury and dementia services, intellectual disabilities and dementia services, and brain injury services and falls prevention. There are many overlaps in terms of programs, services, grants, health outcomes, and, more importantly, money.

Emily found that there’s a great deal of overlap between these grants and funding streams. The structure of Virginia State Unit on Aging compared to others is that it is the third most common structure. The most common is a standalone agency, which would just be a State Unit on Aging department. The least common is social services, having the State Unit on Aging be under a social services agency. Therefore, Virginia really is on par with what other states are doing across the United States. 

In terms of findings related to the impacts of moving AOS to DSS, Emily’s research revealed a legislative impact. There are numerous co-changes that would need to occur, as well as the expertise that the DARS policy division has in providing regulatory guidance and developing the Virginia Plan for Aging Services, which is required under the Older Americans Act. There would also be an administrative impact. There is a lot of collaboration, and separating these divisions would add administrative complexities and reduce efficiency between divisions. 

Emily also found that there would be financial impacts. The DSS staff would have to be trained on these complicated service funding formulas. There would be IT costs in terms of migrating peer-place licenses, and there would be a learning curve for DSS staff. There would also be the cost of rebranding an entire agency, which just happened in 2012. 

In terms of advocacy impact, DARS and AOS are a prominent voice across Virginia for the needs of older adults. If AOS was moved to DSS, Emily thought it would be possible that their needs could be overshadowed by the traditional DSS focus on children. AOS would become a very small part of what DSS does, making aging-related issues less of a priority. 

Based on all of these research findings, Emily’s ultimate recommendation was to keep AOS underneath DARS. By doing so, they would ensure the connection between aging and disability services, reduce administrative complexities, increase the impact of aging advocacy across Virginia, and simplify the structural lines with the typical structure of State Units on Aging in the United States and where the United States is headed.

Fernanda Gutierrez completed her PHPE, entitled Modification of Health Assessments for CHIP of the Roanoke Valley, with the Child Health Investment Partnership (CHIP) of Roanoke Valley. CHIP is a nonprofit organization with a mission of changing the lives of underserved children and their families through access to comprehensive healthcare services and community resources. Children and families are matched with nurses and case managers who conduct regular patient visits. During these visits, nurses and case managers complete health assessments, which are used to monitor and manage the health of families. 

For her PHPE, Fernanda worked with another MPH student to modify selected health assessments with the goal of streamlining workflow and enhancing data collection that could be later used to apply for funding opportunities. To do this, the team first created interview questions that investigated what the CHIP staff thought about the Healthcare and Family Planning Assessment, the Prenatal Experience Assessment and Flowsheet, and the Safe Sleep Assessment. Sample questions in their interviews included, “Have you ever delivered family planning education to CHIP clients?” and “What do you think about the Family Planning Assessment?” 

After obtaining approval from the Virginia Tech Institutional Review Board, the student group interviewed 14 nurses and case managers. They analyzed the results and presented them to CHIP of Roanoke management. Following this, they decided that the best step was to modify the Healthcare and Family Planning Assessment by utilizing the nurse and case manager interviews, the CHIP management input, and a literature review. 

Through their interviews, Fernanda and her team found that all nurses and case managers had previous experience using the Healthcare and Family Planning Assessment and delivering family planning education. They also found that 92% of the staff were satisfied with this assessment, because it was short. Moreover, they found that 43% of the staff felt uncomfortable when discussing family planning with clients. 

Staff indicated that ways to improve this assessment would be to incorporate STD/STI education, female exams, and to create an assessment that brought men and postmenopausal guardians into the discussion, as many of the guardians for the children are either fathers or grandmothers. Staff also indicated that creating a script to deliver family planning would not be useful. 

In terms of the Prenatal Experience and Flowsheet Assessment, the students found that only nurses (5 out of 14 participants) had previous experience using the assessment. These nurses indicated that some improvements to be made included incorporation of domestic violence and developmental stages when talking to the families and creation of a binder with information that future mothers could take home before delivering the baby. 

The deliverables for this project included creating three different healthcare and family planning assessments to target three different populations, premenopausal women, post-menopausal women, and men. The unmodified Healthcare and Family Planning Assessment only touched on methods of contraception. In the new assessments, the students incorporated questions on gender health, birth control use, contraceptive intent,  social and sexual history, STI and STD history, and birth spacing. Fernanda worked primarily on the social and sexual history as well as the STI and STD history sections. 

In conclusion, staff interviews allowed CHIP of Roanoke management to make changes to improve workflow for their staff. The modification of the Healthcare/Family Planning Assessment has the potential to allow staff to have a more holistic understanding of the sexual health of CHIP guardians and the potential to promote STI/STD education.

For her PHPE project, Adrienne Diggs conducted a campus assessment of mental health programming at Virginia Tech in collaboration with Hokie Wellness. She surveyed departments and colleges within academic affairs about mental health programming offered. Mental health programming includes education, resources, interventions, organizations, etc. 

The purpose of this assessment was three-fold. First, it was to determine what is offered across departments. Second, it was to explore which topics seem to be oversaturated or lacking, as well as which mediums are being used. Lastly, Adrienne looked at how Hokie Wellness can be of support and fill in gaps. 

In order to conduct the assessment and collect data, first, Adrienne contacted department heads and directors via email to request details on mental health programming being offered in their departments. These responses were coded into distinct categories: direct services/intervention, event, organization, class/workshop, resource, or training. 

Of the 72 departments surveyed, she had 42 respondents. Of these, 23 offered some form of mental health programming, and 18 did not offer any. The majority of the programming was offered in the form of classes or workshops, such as peer education workshops that Hokie Wellness offers; 20% was offered in the form of resources; and 15% was offered as direct services for intervention. 

Of those that responded, about 55% incorporated some form of mental health programming, which means 44% did not offer any mental health programming at the departmental level. Of all the mental health programming offered, the most common topics were self-care, mindfulness, and relaxation/work-life balance. From this, Adrienne concluded that a main area where Hokie Wellness could be of support would be increased communication between Hokie Wellness, Cook Counseling, and the various departments, as well as increased awareness of resources within said departments. 

Using these conclusions, Adrienne made the following recommendations. Hokie Wellness should work with Cook Counseling to eliminate redundancy in programming, as there seems to be saturation in certain topics. A second recommendation would be to better communicate Hokie Wellness and Cook Counseling offerings in the form of a website or a portal. The third recommendation was to utilize the departmental contacts that Adrienne made while conducting this assessment in order to reach out and offer programming to fill the gaps. 

While conducting the campus mental health assessment, Adrienne reported having learned quite a few lessons. The first was that department heads and directors were not completely familiar with their own mental health programming and resources.Many reported that they offered none, when she knew that they had accessed services through Hokie Wellness. Adrienne also learned that some people contacted felt that it wasn’t appropriate for them to offer mental health resources at the departmental level, showing that there is still a stigma about mental health that needs to be addressed. 

Adrienne noted that there were limitations due to COVID-19. For example, there was a delay in some email responses and an inability to meet in person. She felt that this impacted the response rate, which dropped from 84% last year for the same survey to 58% this year. Adrienne realized that, while COVID made getting responses a little trickier, it also made mental health programming at Virginia Tech all the more important. She felt that this assessment was a great way to gain a better scope of understanding of what programs are offered, which topics are covered, and how Hokie Wellness can work to fill in the gaps.

For her PHPE,  Sakina Weekes developed Blue Ridge Health District’s contract tracer training. COVID-19 is an infectious disease caused by coronarvirus. Most people affected will have mild-to-moderate respiratory illness. The best way to prevent or slow the spread of transmission is through education, and this is where contact tracers come in, by notifying, interviewing, and advising close contacts of confirmed or probable cases about the spread of the disease. 

Contacts are required to quarantine and provide daily symptom checks. However, that is not the case with essential workers. In Virginia, This is done through a program called Sara Alert (SA). The Blue Ridge Health District also relies heavily on a spreadsheet that they named Air Traffic Control (ATC). According to the CDC, on average, there are five close contacts per case. 

In this district, Sakina found that it typically took about three weeks or more to train a contact tracer. Sakina’s objective was to develop an effective training strategy for contact tracers while also educating them and their contacts about COVID-19. Through this process, Sakina and her collaborators created a training group that consisted of veteran contact tracers as well as bilingual tracers to help with Spanish-speaking groups. 

They developed a three-phase training protocol. Phase I is shadowing. Phase II is performing. Phase II is evaluation. Sakina created a contact tracing guide that consisted of background information about COVID-19, contact versus case, isolation versus quarantine, a confirmed case, a probable case, a suspected case, testing, a tracing script, a Sara Alert enrollment sheet, and scenarios. 

Sakina’s phase I of training, shadowing, takes about two days. The trainee shadows the tracer making initial calls, follow-up calls, documentation in terms of SA and ATC, any required consent forms, and following the work flow between contact tracers and their case investigators. Phase II, the performance phase, takes four to five days. The trainee will start making calls and documenting their responses in ATC and SA. The trainer provides feedback between calls. Trainees are also exposed to scenarios so that they can become equipped to think quickly. The last phase, evaluation, is where the trainee is tested to see if they can work independently making calls and completing documentation. 

The guidebook Sakina created includes a contact tracer script to replace the lengthy one that existed previously that was seven pages long. Sakina wanted the script to flow readily, so she created a one-page script. Currently, only supervisors have the ability to use the SA training, so she created an interactive sheet that contains all fields that SA has so that tracers can learn to enroll new contacts. FInally, Sakina created scenarios to help trainees gain experience with commonly encountered situations. 

With this project, Sakina incorporated training phases that would reduce the amount of time required for training and provide easy access to COVID-19 information to create a more efficient contact tracer. Challenges Sakina faced included difficulty coordinating schedules. She also found that some people are more advanced in terms of technology than others, and some people have more knowledge about COVID than others. Flexibility was needed in dealing with individuals coming from a variety of different places. Another challenge she encountered was the continuous change in COVID-19 protocol, SA, and ATC.

Sakina experienced success when her program was implemented and did reduce training duration. They were able to train six new people in a week and a half. The new training process created an open environment for a personal relationship between trainer and trainee, and the new tracers now have easy access to COVID-19 information instead of having to rely on Google searches.

For her PHPE project, Teace Markwalter worked on the Virginia COVID-19 Messaging Study and used these findings to create messaging for the New River Health District. The COVID-19 pandemic led to some confusing and contradictory messages from different levels of the media, government, and agencies. Teace’s project used a survey and focus groups to understand the messages that people heard. She used these findings to create messaging for the New River Valley and a presentation for the New River Health District. 

The objectives of this project were to research how Virginia residents interpreted and responded to COVID-19 messages and to analyze the results to identify public health communication needs in the New River Valley specifically. From there, Teace developed communication and messaging on COVID-19 for the New River Valley. 

One method that Teace used in her project was survey distribution. From there, she organized and scheduled focus groups. When the focus groups were conducted, Teace acted as notetaker and monitor. Following that, she worked on transcription and then identified key themes and takeaways to develop messaging. 

Some of the key themes Teace identified included social pod crossover, which is the concept that when you hang out with one person, you’re hanging out with all of the people they hang out with. Pandemic fatigue was very commonly brought up, as was stopping human interaction, being isolated, being tired of threatening messaging, and only seeing messages about what you can’t do instead of what you can. Mask messaging was also identified as confusing, such as when to wear them and the benefits are. 

Teace used these key findings to develop her deliverables. One was messaging for students around having a safe Halloween, focused on the finding that they don’t want to be told what they can’t do. Teace’s messaging instead offered ideas on safe activities with their friends on campus. Her next deliverable was messaging for New River Valley families, illustrating strategies for a safe Halloween. 

During her PHPE, Teace learned that messaging shouldn’t be broad. Agencies and institutions should create clear messaging targeted toward the populations they want to reach. Additionally, she found that focus groups can easily be conducted virtually using video chat services. Another key takeaway was that effective messaging is key to public trust and buy-in of public health measures. Teace also learned that public health research and practice are mutually beneficial to each other. Teace’s exposure to broader public health experiences included collaboration between public health research institutions and healthcare systems, as this study was done through iThriv,  an effort by UVA, Virginia Tech, and Innova. She also gained experience with coding and transcription,  IRB protocols, and the development of public health messaging.

Laura Lang’s PHPE project revolved around building an effective communication strategy for COVID-19 resources in the New River Valley. She started this project in May 2020, when cases were steadily increasing. The COVID-19 pandemic at that point created a challenge within the New River Valley in terms of creating a positive, unified communication strategy. As cases increased, the need for a communication team and a source of reliable, valid information became increasingly apparent. 

Laura’s objectives throughout this project included creating a logic model for key stakeholders within the community, which included the New River Health District, the police department, Virginia Tech public affairs and media, and collaborative epidemiologists and modelers. Laura initiated and led a positive, unified communication strategy that educated on COVID-19 resources, combated stigma, and highlighted local efforts. Laura focused on identifying and targeting key audiences within the New River Valley, including Hispanic populations, low-literacy individuals, impoverished individuals, New River Valley members, and college students. They used flyers, wallet cards, podcasts, and training packages to communicate with these audiences. 

Laura used a logic model that helped stakeholders and the communication team identify common goals. The team created flyers because they noticed that both the English and Hispanic communities needed guidelines and recommendations for hygienic practices if they contracted COVID. At that point in time, few people had been infected, and it was seen as a stigma.

The flyers included a stay-at-home section, what to do if you don’t have a separate room or area, identifying people not living in your home who can help out with different tasks, and a “contact us” section for more help. 

The team also developed wallet cards that have now been distributed throughout multiple counties and geriatric communities. They were made to be specific to each county, including Floyd, Giles, Radford, Pulaski, and Montgomery Counties, showcasing local resources that don’t require insurance or immigration status, as their target populations were Hispanic and low-literacy, low-income areas. They hoped to build trust in the health departments, so they included the New River Health District in the bottom section in the logo.They tried to identify resources such as local food banks, mental health providers, and medical providers that might not require insurance. 

Laura and her collaborators recorded 12 podcasts, highlighting local efforts from professional students and others to not only educate the community but to also show that the community was working together to combat COVID-19. On average, they had about 200 listeners from outreach within Virginia Tech, Facebook, and local news stories. They called the podcast “Your Health Hotline,” and they showcased local efforts, including police officers, local testing sites, and professional graduate students. They included the logos of the New River Valley Public Health Task Force, New River Health District, and the Public Health Program at Virginia Tech. 

Laura identified some of the lessons she learned throughout this process. One lesson was the importance of networking and building a professional network. Collaborating with graphic designers to develop the flyers was also critical. Laura learned that it was more effective to have flyers with more images and diagrams than text to catch attention and better convey information. They did try to keep their text at the fifth- and sixth-grade reading level so that everyone could easily understand it. Laura learned that communication strategies can take time. Specifically, the podcasts at first had few listeners. She felt this was because they started out being more interrogative. As they progressed to a more discussion-based format with shorter episodes (about 30 minutes in length), they saw an increase in listenership, based on charts from Spotify.

Andrea Laird’s PHPE project was Food Safety Training Development During COVID-19. Andrea worked with Virginia Tech Dining Services, which caters to thousands of students, staff, faculty, and community members in Blacksburg every year. They’re consistently ranked among the top 10 for best campus food and are renowned for their high-quality food. With their high volume of sales, there needs to be a high commitment to food safety, employee wellbeing, and quality service. 

For her PHPE, Andrea worked with Laura Pontier, the assistant director of operations development in Dining Services, to update the existing food safety training and to develop a new program in the face of the COVID-19 pandemic prior to reopening for the fall 2020 semester. The objectives of this project were for Andrea to gain experience in the development of creating an educational program, to create engaging programming for the target audience, and to determine if the products were effective in teaching the content. 

Andrea worked on three different projects for this internship. The first was to edit the Food Safety 100 training to increase accessibility and clarity and to remove outdated information. Dining Services has many employees from other countries and for whom English is not their first language, and Andrea wanted to make the training more accessible for them. She added a glossary and visual aids that increased accessibility for these English learners. Andrea also added information on food hazards and corresponding practice activities. 

For her second project, she developed a COVID-19-specific training for Dining Services. Andrea created a click-through computer module based on the planned procedures that were implemented during the semester, including a standardized assessment for evaluating the intake of the information for those taking the training. 

The third project Andrea worked on was updating the hazard assessment forms for all of Dining Services. This consisted of touring all of the dining facilities and evaluating the existing forms, noting new hazards, and removing hazards that no longer existed.

In the COVID-19 training that Andrea created, she included interactive features and additional resources. For example, there are three different types of disinfectant used. By clicking on an image of each, the safety data sheet popped up along with a description of what people need to know when working with that product. 

Andrea also developed 18 hazard assessment forms. She toured the dining halls and checked off what hazards exist, noting what they were and what protection employees had against them. These forms are actively in use as part of the hiring process. New employees must view the form and sign off on having reviewed them. 

The Food Safety 100 course is used by both new employees and those requiring a refresher course. This is the primary study resource for anyone taking the test. The COVID-19 training is required by all current employees of Dining Services, including salary, wage, and students. All of the current employees have achieved an 80% or higher on the assessment. 

Andrea notes that during her project she learned that information can change frequently, requiring multiple revisions of her work just to ensure that it stayed up to date. She also noted that cooperation between different departments, especially in a university during COVID, can be really difficult. Sometimes communications are slow or delayed and require more time than originally planned. Andrea also learned that one needs to consider the audience when designing content and assessments to ensure that the product is useful and actually targets the focus audience. 

As far as future projects, Dining Services is receiving feedback on the COVID-19 module through student communication emails. They will update the module as information changes. Andrea is currently still employed by Virginia Tech Dining Services and is in the process of creating additional food safety training, Food Safety 200. By adapting the existing materials, she hopes to take this task in a similar direction as the other two modules she created as part of her project.

Kendra Byrwa completed her PHPE with the epidemiology team at the Roanoke City Health Department. Kendra’s project was to implement the use of Sara Alert in the Roanoke City and Allegheny Health Districts in the midst of the COVID-19 pandemic. 

Epidemiology teams are essential in studying the determinants and distributions of health and disease in populations. In response to COVID-19, the epidemiology team at the Roanoke City Health Department grew rapidly, and it consisted of many epidemiologists, nurses, case investigators, and contact tracers. 

Before the pandemic, and even in the early stages of this pandemic, traditional contact tracing consisted of daily follow-up phone calls between a contact tracer and a close contact. Paper logs were used to record each close contact’s daily symptoms and past activity. This method was effective with a small caseload, but the nature of COVID-19’s community spread called for an alternative monitoring method. 

Virginia’s transition to Sara Alert was started by the Virginia Department of Health (VDH) in May 2020, with the hope that each health district would follow suit with implementation. Sara Alert is an open-source automated program for patient follow up developed by Mitre. 

Since its transition to Sara Alert, Virginia has enrolled thousands of monitorees into the system. Public health officials enroll cases and close contacts into the software using basic demographics such as address, phone number, and more specifically, exposure or symptom onset dates in order to determine the monitoring period. 

Monitorees can choose to receive a daily text, phone call, or email alert to access a survey of symptoms during their monitoring period. This information is then sent back to Sara Alert for public health officials to monitor symptomology without making manual communication contact. There are two types of monitoring for COVID-19 within Sara Alert, close contacts as an exposed individual in quarantine or a confirmed COVID-19 case. 

The objectives of Kendra’s PHPE were to successfully implement Sara Alert in the Roanoke City and Allegheny Health Districts and to train the staff to efficiently enroll and monitor both cases and contacts in Sara Alert. 

Kendra began to learn about Virginia’s transition to Sara Alert by interviewing Marshall Vogt, an epidemiologist and COVID-19 containment co-lead at VDH in Richmond, who emphasized how useful he thought this tool would be to have a statewide system that would ideally lead to better surveillance and early detection of disease within the community. 

In order to become proficient in the software, Kendra taught herself how to navigate through Sara Alert under her preceptor’s guidance. The software has a user manual, but at nearly 100 pages long, Kendra knew that public health officials most likely wouldn’t have time to review the entire manual. Kendra reviewed the manual, watched tutorial videos, asked questions, and completed entries into Sara Alert in order to develop a simplified training program for the health department. 

Kendra held safe, in-person training sessions at Roanoke City Health Department. Virtual training sessions were held over Zoom, and a copy of the training session was recorded and posted into the Google Drive for the epidemiology team for future reference. Kendra is still part of the epidemiology team at Roanoke City as a case investigator, and she remains a point of contact for Sara Alert directed questions. Between all of the versions of Kendra’s training sessions, over 20 staff have been trained on Sara Alert across the health district. 

Kendra created two quick-reference handouts, one for the enrollment workflow and one for the daily workflow in ideal monitoring conditions. The layout of the sessions consisted of a brief PowerPoint presentation focusing on a screen sharing of Sara Alert to show trainees the process from start to finish, from collecting their cases to enrolling into Sara Alert. 

Her handout on how to enroll monitorees breaks down the process from logging in through each page of Sara Alert until you get to the end. Kendra’s second quick-reference handout covers the monitoring workflow in ideal situations. The trainee starts at a green dot and works their way through checking each tab of each dashboard until they arrive at a red dot. The last thing they check is their isolation monitoring records requiring review. 

Kendra noted that Sara Alert has been useful in implementing a more community-accessible monitoring system and is improving the surveillance of COVID-19 cases and contacts, especially detecting early signs of disease in close contacts. Additionally, analytics and statistical reports are available using demographics and other reported information. These reports are available at the jurisdictional and state level. 

Kendra reported some limitations to this project. This training was established in the midst of an extreme increase in cases where staff were already spread thin. The training was not mandatory for staff, and Kendra felt that it would have been beneficial if Sara Alert was implemented before May so that staff could have worked toward developing proficiency before responding to the emergency. 

The use of Sara Alert is still not widespread, and it hasn’t been completely adopted by every jurisdiction in Virginia. If Sara Alert were more common throughout the state, or even the country, perhaps more community members would want to participate in the software and would be more likely to follow up. Kendra noted that the analytical portion of Sara Alert would be incredible to compare across the entire country. 

In the future, Kendra felt that Sara Alert could be useful for other communicable diseases. It has automated the process of contact tracing, allowing the community to become more actively engaged in the health department’s efforts to curb disease. Sara Alert will eventually be connected to VEDSS, which is Virginia’s epidemiology database of reportable diseases. This will simplify data entry and connect data across many softwares, increasing accuracy and reliability of analytics and data in general. Kendra believes it would also be important to collect feedback on the use of Sara Alert in order to better serve the public health users and also from the community to see how they’re responding to the alerts.

Sade Bowers completed her PHPE with the Stanton Health Department in the Central Shenandoah Health District where she was involved in COVID-19 testing event communication for the drive-through testing events that were hosted.

The Central Shenandoah Health District is a part of the Virginia Department of Health and is comprised of seven health departments that serve approximately 293,000 citizens living in the counties of Augusta, Bath, Highland, Rockbridge, and Rockingham along with the cities of Buena Vista, Harrisonburg, Lexington, Stanton, and Waynesboro. In response to COVID-19, the health district that Sade worked with hosted free drive-through testing events. They executed a series of different communication strategies in pursuit of maximizing attendance at these testing events. 

Sade’s objectives were to evaluate appropriate communication strategies and help literacy levels for target audiences along with developing culturally competent materials for the community. In addition, she wanted to ensure that she was practicing community health education communication skills, and she intended to inform future communication plans, such as for vaccine dissemination events.

The communication strategies that were used included emails from the population health outreach department. Event information was shared with local media partners, who then disseminated the testing event information through their various channels. In addition to that, the health department posted Facebook updates about testing event availability. 

For data collection, patients were asked how they found out about the COVID-19 testing event before they left that event. This data was collected at a total of 17 testing events spanning from May 27 to July 16, 2020. After the data was collected, Sade prepared a communications after-action report, where she analyzed the effectiveness of the various communication strategies. This document was to be used to inform the health district’s formal final after-action report in the months to come.

Her communications after-action report showed the total reported modes of communications that Sade collected from the testing events. There were 2,234 respondents. Sade noted that during the time period that her report covers, there were no testing events in Highland County, so that is not included in this figure. 

In preparation for future communication plans, Sade felt that it was worth noting the differences in reported modes of communication for testing events in different areas of the health district. Different areas are composed of diverse populations with differing access to resources and information. For example, James Madison University is located in the health district in Harrisonburg and is composed of a large student body who likely have access to and frequently use social media, whereas less populated areas in the health district, or areas with a greater proportion of elderly individuals may have less access to social media. 

Sade’s results section showed the most reported and least reported modes of communication for the different areas. Harrisonburg had the greatest number of respondents where social media was most reported, whereas Bath County, with the least number of respondents, is a more rural area. While social media was most reported for this area, many people found out about the testing events via newspapers. 

Sade recommended that a more comprehensive community contact list be solidified for the health district. As they move forward with future communications plans,  this will allow them to communicate in a timely fashion to as many local organizations as possible. She also suggested executing strategies geared toward information dissemination for those without access to the internet, as those populations may be more vulnerable. Along with that, Sade recommended that translation services and materials be improved to increase access to public health information. She also believes that tailoring modes of communication for each county and city based on what is most effective as laid out in her report would be beneficial. 

Sade concluded that the health district serves a very diverse population of people, which should be accounted for when preparing future communication and emergency response plans. Conducting research as simple as surveying COVID-19 testing event patients yields valuable data that can be applied to improving access to crucial public health information. This lends a greater understanding of what modes of communication contribute to public health event participation, which will in turn be useful for future dissemination of COVID-19 vaccination messaging.

Megan Toms completed her PHPE with the Johns Hopkins University Applied Physics Laboratory developing language for the framework between public health surveillance, infectious disease modeling, and operations. She then applied this framework to evaluate the performance and accuracy of models used in forecasting the COVID-19 pandemic. 

Public health surveillance, infectious disease modeling, and operations are interdependent and crucial for the management and control of a public health emergency. Operational decision-makers frequently rely on infectious disease surveillance data to provide information on disease characteristics and may utilize models to determine how interventions can help slow and suppress disease spread or predict when and where deployment of resources should occur for optimal preparedness. The available information relative to an outbreak is vital in informing operational decisions, thereby exemplifying the need for accurate and timely data collection and reporting through surveillance efforts. Accuracy of models is paramount to inform sound operational decisions, and a major component of overall accuracy stems from the data used. Utilization of models may enhance preparedness for subsequent weeks, and potentially months, through predictions of the potential magnitude of the epidemic under various assumptions. Models can demonstrate which policies for disease mitigation are most likely to be effective and valuable. 

The framework was constructed through defining and explaining the relationships between the components, and a literature search was utilized as evidence to support the framework. Models were assessed by collecting information on model type and characteristics, assumptions, and data sources. Forecasts for incident deaths were compared to actual provisional data from the CDC. While the framework is complete, the data analysis for model performance is still in process due to the significant delays in reporting of surveillance data. Therefore, concrete results and conclusions have been postponed until adequate analysis can occur. 

The first step of developing the framework is defining its parts. The CDC defines public health surveillance as the ongoing systematic collection, analysis, and interpretation of health-related data essential to planning implementation and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control. Infectious disease modeling is the process of forecasting disease or epidemic progression, assessment of mitigation strategies, and elucidation of data trends by incorporating mechanisms of epidemiology, statistics, biology, sociology, and economics in addition to those of various other specialties. Finally, logistics operations during a disease-centered public health emergency refers to the deployment of material and nonmaterial resources needed for prevention, control, and treatment or management of disease. 

Surveillance data informs models and operations directly. However, models require surveillance data to adequately inform future operations. The policies decided upon and enacted through operations and evaluation of surveillance data can then also feedback to the models to impact their assumptions. 

A major limitation of this evaluation is the significant delay in reporting of surveillance data. The provisional data is continuously being updated, including data for the spring of 2020 forward. Therefore, the current evaluation may not be representative of the true model performance. Incident death data is the initial gold standard for evaluating the accuracy of projections of epidemic models. However, this is dependent on the quality of the surveillance data. Incident death projections were consistently reported, starting at the target week of August 1. Therefore, additional collection of projections is needed. 

Additionally, for complete analysis of overall accuracy, model projections should also be compared against case and hospitalization data, as surveillance of these metrics improve. Comparing the models to their own performance over time and correlating improvements in accuracy to updates in the model or data sources is of interest, as is evaluation of model projection accuracy associated with data type utilized. 

Sterling Senger completed a descriptive analysis of COVID-19 outbreaks in the Central Shenandoah Health District (CSHD) for her PHPE. The CSHD services Augusta, Bath, Highland, Rockbridge, and Rockingham Counties and the cities of Buena Vista, Harrisonburg, Lexington, Staunton, and Waynesboro. Sterling noted that a large number of people in this area work in the many poultry plants prevalent in the region. 

The goal of her PHPE was to identify patterns or trends in the data that could lead to further insight into the outbreaks of COVID-19 in April 2020 in the CSHD. Sterling set out to provide descriptive statistics on age, sex, race, ethnicity for poultry plants, long-term care facilities, and non-outbreak-associated populations, and also to look at the frequency of some of their symptoms and hospitalization rates. Her second objective was to prepare an informal report of her findings that could help people outside of the field of epidemiology understand what’s going on and increase data visualization. 

Sterling received an Excel sheet that included all of the positive COVID cases for Harrisonburg and Rockingham County. She cleaned the data and used RStudio statistical software to show clear trends in the data and core differences in demographics, symptom frequency, and outbreak frequency. Her total population was about 2600 people. For the non-outbreak-associated population (anything not epidemiologically linked to another outbreak), there were about 1800 cases. For poultry plants, there were 365 cases. The long-term care facility population was 278.

Sterling created pivot tables using Excel to increase data visualization of the trends in the data. Sterling found that the White race had significantly higher cases of COVID. There were significantly more Hispanic cases than non-Hispanic cases in the poultry plants, and the opposite was true for long-term care facilities, where there were significantly more non-Hispanic or Latino cases. For the not-an-outbreak group, they were found to be roughly about the same, but with more non-Hispanic or Latinos. 

Sterling grouped together symptoms that were similar, such as respiratory symptoms of COVID-19. She found that cough for the not-an-outbreak group was significantly higher than any of the other symptoms they reported, and the same was true for the poultry plant workers. For GI symptoms, she noted that there was a huge spike in diarrhea cases in long-term care facilities versus the other symptoms reported in that area, and the same was true for the not-an-outbreak group. For flu-like symptoms, she found that chest pain was significantly less than any of the other symptoms that were reported, while things like myalgia, fevers, and headache were higher in the not-an-outbreak group. 

Sterling suggested that a future research direction could be continuing the analysis for outbreaks in April 2020 for other counties, analyzing the outbreaks at JMU versus these outbreaks, and comparing the number of asymptomatic versus symptomatic individuals in each demographic group.

For her PHPE, Caroline Marti completed a service area analysis of COVID-19 testing sites in the New River Health District (NRHD). In response to the COVID-19 pandemic, the New River Health District (NRHD) established free community-based testing sites. These testing sites helped mitigate socio-economic barriers for those who may not be able to afford testing for COVID-19 or travel to a testing location. In addition to the health department’s testing sites, local hospitals, Carilion Clinic VelocityCare Centers, CVS pharmacies, and Virginia Tech’s Schiffert Health Center all established COVID-19 testing capabilities in order to increase the amount of testing available. Geographic information systems (GIS) can be used to visually display the distance that residents in the NRHD need to travel in order to receive a COVID-19 test. 

Caroline’s main research questions were, “Are there any obvious areas in the NRHD that are lacking a nearby testing location?” or “Should the health department consider establishing a new COVID-19 testing location?” Caroline ran a service area analysis of COVID-19 testing sites through ArcGIS Pro. Testing locations included the health department community testing sites, Virginia Tech’s Schiffert Health Center, local hospitals, the VelocityCare Centers, and CVS Pharmacies. She then ran a service area analysis of these testing locations and tabulated the intersection of the service area analysis to the counties in the New River Health District. This resulted in a surface area analysis map of the NRHD. She found that the majority of the New River Health District is within five to 20 minutes of a testing site. Many of the time travel areas overlap where people are being served in multiple ways. 

Caroline also noted that the service area generally follows major roads, since they allow for faster travel. The lighter colors represent a shorter time to travel to the nearest COVID-19 testing site. When we tabulate percentages using the intersection between the NRHD and the service area analysis, we see that Radford City has the best coverage. 

Caroline relayed that service area analyses don’t include population data. She had to take into account unpopulated areas in her map, such as in northern Giles where there are areas without roads such as unpopulated mountain ridges, rivers, campgrounds, and national forests. In northern Giles, specifically, these areas are Jefferson National Forest to the east and Millcreek Nature Park trails to the west. 

Caroline adjusted coverage based on some population data that we know. In this case, the area of national forest was removed from the service area analysis to adjust for unpopulated areas. She found that 55% of the estimated population area in the NRHD has to travel zero to 10 minutes to their closest testing site, which is very good. Travel times that are less than 30 minutes are usually considered well-served. This means that 90.6% of the New River Health District is served well, and that doesn’t exclude campgrounds, unpopulated mountain ridges, or rivers. 

Caroline provided this information to the New River Health District to use to decide whether they want to establish a new COVID-19 testing site or to help prepare future sites for vaccines or emergency supplies. She recommended that possible testing locations to investigate could be East Montgomery High School or Shawsville Middle School in southern Montgomery County, as they should expand service to Floyd pretty well, and possibly to Roanoke. Caroline found that the NRHD is well-served, location-wise, but noted that it’s very important for the health department to consider the capacity of testing inside these testing sites, as there may not be enough tests for the demand.

For her PHPE, Lauren Blackwell worked with the Center for Biostatistics and Health Data Science (CBHDS) at Virginia Tech to explore the relationships between mobility changes, COVID-19, and demographic and health factors at the county level.  The goal of her report was to examine the effects of a set of county-level variables on changes in social mobility related to the COVID-19 pandemic. Lauren noted that mobility and social distancing are very important to study, because COVID-19 is known to spread through person-to-person contact, and we expect that counties which greatly decrease their mobility and contact will see fewer cases and deaths compared to counties which do not. For example, when people have poor mobility practices, it can have a significant impact for universities, such as Chapel Hill. 

The objective of Lauren’s project was to identify variables that affect mobility related to COVID-19 and to determine how changes in these variables affected change in mobility. For the methods, Lauren and her collaborators looked at mobility data collected from cell-phone tracking company Unacast. The measure of mobility for each county was the percentage by which mobility decreased compared to a baseline computed in early March. Lauren examined 11 variables to see which varied significantly with mobility and then used linear regressions to quantify the relationship between these variables and mobility decrease. 

Out of the 11 variables that they looked at, four were significant. On average, they found that counties with a higher median household income had a larger decrease in mobility from baseline when compared to counties with a lower median household income. For the GOP share, counties with the higher GOP share had a smaller decrease in mobility from baseline compared to counties with the lower GOP share. Adult obesity and percent of population in rural areas had similar results. For the median household income, they saw that for every increase in median household income, the mobility decrease increases on average by 0.032. For the GOP share, for every 1% increase in GOP share, they expect to see mobility decrease go down by 0.3%. 

Lauren’s data analysis was able to determine which groups were affected by mobility the most across different counties. The counties with lowest mobility decreases had larger percentages of GOP voters, lower household income, higher obesity rates, and more people living in rural areas.

Jaclyn Abramson’s PHPE project was on COVID-19’s impact on those who use drugs in Southwest Virginia. She worked with the Virginia Harm Reduction Coalition (VHRC), which is a nonprofit that provides harm reduction services to more than 400 individuals, most of whom reside in the Roanoke Valley. More than 40% of their clients are experiencing homelessness. When the COVID-19 pandemic arose, it created a unique threat to people experiencing homelessness and who use drugs, because they are at higher risk of contracting the virus and higher risk of severe illness if they do contract the virus. 

Through a collaboration with the New River Health District and with funding from Virginia Rural Health Association, VHRC was able to implement project goals, including goals to help slow the infection rate of the virus in a high-risk population, increase adoption of preventative hygiene, provide its members with safe places to recover, and connect individuals to care as needed. 

Jaclyn achieved these goals through the development of educational materials in the form of handouts for individuals after testing and additional information on how to protect themselves and lower the risk of infection, general tips for safer use of drugs during the pandemic, and information on testing, transmission, and symptoms. Jaclyn and the group also distributed personal protective equipment, such as reusable cloth face masks, hand sanitizer, and soap.

COVID-19 testing was offered through the VHRC’s partnership with the health department, where the VHRC staff and volunteers were trained to conduct the nasopharyngeal swabs. They offered testing not only onsite at their clinic but also throughout the southwest region at outreach events. 

Jaclyn conducted a needs assessment survey to evaluate the resources provided by VHRC to assess a variety of factors and to provide recommendations for future efforts. Overall, it was a 20-question survey that was conducted anonymously to 33 individuals in person. It targeted individuals who are already coming into the office for other services. 

Jaclyn was able to test about 250 people; however, only 65% were able to be contacted to receive results. Two people were positive and were provided with housing and financial resources for isolation. 

Results from the needs assessment survey were broken into three categories. For health behaviors, mask use for the protection of themselves was 42% and for the protection of others is 48%. Forty-two percent of the population report rarely or never wearing a mask in public. PPE usage of items provided by VHRC was 94% for hand sanitizer, 85% for bar soap, and 58% for masks. Individuals reported always or sometimes using these items. 

For health risk assessment, 73% of individuals report no change in their drug use. Fifty-eight percent of individuals reported an increase in financial, mental, and emotional stress; 37% of individuals said that they would not want to be tested; and 30% said they were unsure if they wanted to be tested. 

For knowledge of COVID-19, only 15% said that they received their information from VHRC, and 64% said that they were unaware that VHC offered COVID-19 testing.

Further recommendations for VHRC would be to include informational classes such as mental health and addiction counseling, safer user and sex meetings, and self-care workshops and educational resources. Other things clients would like VHRC to offer included CPR, phlebotomy, and Narcan training, assistance on jobs, and acquiring proper identification. Because COVID-19 is a novel virus, flexibility and adaptability to the guidelines and education are needed as recommendations may change. 

Some recommendations Jaclyn provided based on her experience and the survey results included better awareness and marketing for when testing is being held and more joint outreach events where education on the importance of testing and on the importance and effectiveness of wearing a mask to reduce the risk of contracting or transmitting the virus. Additionally, she felt it was important to continue to supply distributed items, as they are being utilized efficiently, and to address educational deficits identified by the needs assessment. 

Throughout the project, Jaclyn faced several challenges. It was initially difficult to encourage some clients to get tested, as the nasopharyngeal swab is uncomfortable. Follow up with this population, especially for results notification, was incredibly difficult due to the barriers with technology and their overall mistrust. Testing also had to be halted for about two months due to a Clinical Laboratory Improvement Amendments investigation.

Data collected was from a subsample population of VHRC clients and therefore some information and health behavior changes may be different for VHRC clients in other areas reached through outreach events around the region. 

Samuel Miller focused his PHPE on a COVID-19 messaging study that sought to show the impact of COVID-19 on the Black and African American community. 

There were three individual peaks in cases of COVID-19 over time in the United States, with the largest peak being 181,000 cases in one day on November 14. On April 9, 2020, the Annals of Internal Medicine published a cross-sectional study concluding that initial COVID-19 messaging was inconsistent and caused many Americans to lack important knowledge about the virus. Additionally, early Pew and Gallup polls displayed that the public’s overall opinion of media coverage about COVID-19 was flat or favorable. 

More specific to the focus population of this study, Black or African American people are more than 2.6 times more likely to catch COVID-19, 4.7 times more likely to be hospitalized from COVID-19, and 2.1 times more likely to die from COVID-19 in comparison to their White counterparts. 

As a result of this, a Virginia statewide survey and focus groups were conducted to understand how Virginians responded to COVID-19 messaging and the overall public health impact of COVID-19 on vulnerable populations. The primary aim was to use the resulting data to develop educational materials that would highlight concerns, interests, and needs about COVID-19 for the Black and African American community within the United States. 

The Virginia state-wide survey hosted five focus groups with 22 total participants between the dates of July 15 and September 25, 2020. Three of the eight focus groups highlighted and explored the experiences of Black and African American participants. The participants answered 23 questions to further understand how Virginians received, interpreted, and responded to messages related to COVID-19 as well as how and when these messages influenced behavior. 

Based on those results, a semi-structured thematic coding process was used to identify recurring patterns in those participant responses. A Microsoft Excel document was used to quantify patterns into 11 overarching themes. Each one of those individual themes was then referenced with a numerical time. From there, Adobe Illustrator and Adobe InDesign were used to create the infographics that translated those themes and patterns into visual graphics. 

Preliminary feedback was received from primary investigators and the research team to review the accuracy of the data interpretation and content presentation. Additional feedback from communications and graphic design professionals was used to improve legibility, clarity, design, user friendliness, and comprehensiveness of the infographics. 

Multiple iterations of the infographics were developed to ensure that they were as legible as possible. Each of the four infographics is based on a color scheme created to represent Fall in the Blue Ridge Mountains. These colors are consistent throughout each of the infographics to create cohesiveness so that they can either be used individually or together as a whole. 

The first graphic is a COVID timeline, showing the impact on the Black community from March 2020 to November 2020. It shows each one of the individual aspects that have affected Americans in each one of the particular months throughout the entire year of 2020. There’s a QR code on each infographic to access more information using a smartphone. 

The next infographic shows mask usage across the United States. Currently, there are only 35 states that have mask usage laws, but it’s recommended across all 50. It also shows each of the different types of mask, how important they are, and how well they filter large droplets and aerosols. 

The third infographic covers how to better your mental health during quarantine and provides five quick tips to maintain proper mental health during quarantine as well as different statistics. 

The final infographic takes two questions from the focus groups and answers them with information from the CDC. 

Researchers can utilize surveys and focus groups in order to explore perceptions, misinformation, and conspiracies about COVID-19. Sam’s infographics create an opportunity to translate data content into content-specific and culturally relevant COVID-19 education.

The audiences of focus need to be incorporated as stakeholders for future research, especially in the design process, so that they can increase and enhance generalizability to the larger population and allow people to understand and educate themselves further about COVID-19.

For her PHPE, Chloe Loving worked with Empowered Options, a program that focuses on connecting high-risk women to reproductive health services. Empowered Options is an intervention through the New River Health District and was originally implemented in 2018. Barbie Zabielski, who serves as the primary community health educator as well as program lead and coordinator, did much of the work to secure this program. 

Empowered Options aims to decrease unintended and substance-affected pregnancies among women released specifically from New River Regional Jail in Dublin, Virginia. The long-term hope of this program is to prevent neonatal abstinence syndrome (NAS). NAS occurs when women use substances while pregnant, and the child is born either addicted or highly dependent on substances. We see this the most intensely with opioid use. 

Sexual and reproductive health classes were offered several times a month onsite at the jail, and eight to 12 women were invited to each session. They were unique women with no repeat attendees. The women were also offered family planning clinics through the New River Health District, where they were able to talk to nurses and gynecologists, be tested for any sexually transmitted infections they might have been concerned about, and then were offered a variety of birth control options, from long-acting reversible contraception such as implants and IUDs, to oral contraception, depo shots, and nuva rings. Chloe and her counterparts talked with each woman about her lifestyle and what she would like in order to make the best choice possible. 

Case management was facilitated pre-release and early post-release in order to help clients locate treatment, job assistance, housing support, and community clinics. A Medicaid application was included along with a large portfolio of resources and reading material. Condoms were also waiting for them upon release with their items.

A mixed-method survey was completed by 259 women based on constructs found in the Health Belief model. The qualitative answers were coded and then evaluated. Some of the women expressed that this was their primary exposure to sexual health education, and they found it helpful. They had not dealt with a lot of this informational material before, and they appreciated the very trusted source it was coming from. One woman wrote, “I really like the honest comparison of the birth control methods. I think the instructor’s straightforward manner regarding sex is refreshing in the South.” Another participant stated, “Changed perspective on opiate use because of its effect on children.” Connection to resources was another theme that was positively regarded, as was the sexual health testing and allowing each woman to choose her birth control method. Another comment was, “I can get and have options with birth control and help getting out of my abusive relationship.”

The instructor was incredibly important in this intervention, as she created a lot of trust with the participants. One participant said, “You don’t judge anyone. Answered everything I needed and explained where I could understand. Thank you.” The instructor’s humor and kindness were noted throughout the surveys, and her honesty and transparency allowed the women to trust her. They expressed the feeling that she really did care about them. 

Chloe reported that they used a mixed delivery of information to include videos and demonstrations. They used a lot of humor along with this intense information. The participants noted that they appreciated this fun way of mixing it up. Many women who participated stated that they felt empowered and that they were, “Learning how to control my life.” The participants reported feeling ready to make behavior changes. 

The survey revealed fewer responses with regard to dislikes. Participants either didn’t answer the question of “What did you dislike most about the education?” or they put “N\A.” The women mainly reported that they disliked being in jail. They found their peers distracting. Some felt the class was too short, while others felt it was too long. A few of the women mentioned that the subject matter was triggering. There was a video showing a baby going through active withdrawal. Here we see the comment, “The awareness of the infant (NAS) was very hard to watch but necessary.” 

Overall, Chloe found Empowered Options to be a unique and powerful participant-based program based around the needs of the population. She saw that the women benefitted the most when they utilized all of the resources offered. The health educator used a harm-reduction, participant-focused approach that fostered meaningful relationships, allowing deeper conversation about what was really going on in the participants’ lives. 

Chloe felt that the constructs used from the Health Belief Model targeted effective change. The women learned more about related outcomes as well as seeing the severity and susceptibility, and they talked about perceived barriers and benefits, and increasing the benefits while making the barriers lesser. 

Chloe noted that, because this was a program that decreased the barriers, many women were able to benefit, especially from the onsite resources and the long-term management plans. Upon completing this program, many of the women felt ready to make these choices and to understand how these decisions will go forward in their lives. They felt cared for, invested in, valued, hopefully leading each woman to make better decisions in a way that they feel empowered in their sexual health.

Callyn Niesen worked with Lisa Homa and Dr. Kathy Hosig on a Virginia Tech Center for Public Health Practice and Research project, Empowering Healthy Lifestyles to Reduce Obesity in Petersburg City, Virginia for her PHPE. 

Callyn reported that Petersburg has an adult obesity rate of 41.7% based on the 2015 Behavioral Risk Factor Surveillance System. Petersburg is also ranked at 133 out of all 133 counties in Virginia based on the 2020 county health rankings. Callyn found that social determinants of health that may contribute to obesity and diabetes prevalence in Petersburg include racial distribution, low income and poverty, food insecurity, poor access to medical healthcare, and inadequate health education and low health literacy. 

The objectives of the Empowering Healthy Lifestyles program are to demonstrate progress on activities to increase access to healthier foods in Petersburg City, to demonstrate progress on activities to connect safe and accessible places for physical activity, and to increase access to places that provide physical activity and healthier foods. The long-term goals are to increase purchasing of healthier foods and to increase physical activity, with an emphasis on walking. 

This year, the program is focusing on increasing access and purchasing of healthier foods. One way this is being achieved is through establishing healthy nutrition standards for key institutions; working with food vendors, distributors, and producers to enhance healthier food; and exploring additional evidence- and practice-based interventions to increase good nutrition and physical activity. 

Callyn created three deliverables for the project. The first was a social media marketing document for use on the social media pages for Petersburg Health Options Partnerships (PHOPs) and River Street Market. To do this, Callyn collected data on what the team needed for their social media marketing and what strategies they wanted to use to increase participation and engagement, and then she used evidence- and practice-based data to outline the marketing and engagement tools for the Facebook pages to provide a straightforward and useful guide for practitioners to use. 

Her second deliverable was the POP! Market interim data. She analyzed POP! Market customer survey data using Excel. When customers came to the POP! Market, they would submit this survey based on what they enjoyed, what they’d like to see, where they heard about the POP! Market, etc. She grouped the qualitative responses appropriately, which ultimately led to the creation of charts, graphs, and visuals. Callyn presented the results through a Word document and a PowerPoint, which was shared with the PHOPs ground team and stakeholders. 

Callyn’s third deliverable was a healthy nutrition standards guidelines quick guides for five community sites and institutions. She utilized FDA and CDC evidence-based nutrition guidelines and practice-based models and catered them to different community organizations. She then created five quick guides for use in various community organizations, to include worksites, faith-based institutions, community centers, food pantries, and possibly after-school programs. 

In researching social media marketing, Callyn learned about methods of promotion frameworks, which include assets, awareness, and engagement. For assets, she learned that you should have strong congruence between pages by using the same high-quality photos and logos and to have sufficient information on your website. Awareness entails utilizing emotions and emojis, even to include a “checking-in” button where customers can check-in to your program activities. Engagement includes featuring users and clientele as the heroes of the post and calling users to action by asking for likes, comments, and follows. 

For the POP! Market interim data, she created graphs to demonstrate such information as how people found out about the POP! Market. Most people found out through Facebook. Callyn also created healthy nutrition standards based on the 2015-2020 dietary guidelines to show community sites different ways to implement these standards, such as by providing fruits with no added sugar, having non-fried vegetables, and offering whole-grain products. 

Callyn was successful in completing her proposed deliverables, including the interim analysis of the POP! Market survey data, increasing user engagement on the PHOPs and River Street Market Facebook pages, establishing the Healthy Nutrition Standards for five institutions, and creating the social media marketing document for use with the programs’ social media pages. One suggestion Callyn had for future implementation was to create a food pantry ranking system training.

For her PHPE, Hannah Reed worked with the New River Health District (NRHD) to assist with COVID-19 mitigation strategies for incarcerated populations within the region. 

The NRHD oversees five counties within the New River Valley (NRV). Within these counties, there are three correctional facilities. Early in the pandemic, public health officials from the NRHD teamed up with correctional facility officials to develop a strategy to protect both inmates and staff members from contracting COVID-19 while in the facility, or if they came into the facility with the disease, to prevent it from spreading. 

As an aspiring future public health professional as well as an infectious disease physician, Hannah wanted to gain insight into infection control within the correctional facilities to expand her knowledge of working with vulnerable populations. She wanted to learn how to manage COVID-19 infection control practices and programs, because she felt that this will be important moving forward in her career. She wanted to compare different intervention practices for infectious diseases among different facilities, gain skills in program monitoring and evaluation, and, finally, build clinical skills. 

To achieve this, she started off with meeting with the correctional facility authorities to discuss what the needs were and what resources they had available to execute these protocols. Then, she worked together with them to design these mitigation protocols with the resources that they had as well as what assistance the NRHD could offer. Hannah and her team then trained the facility staff to conduct their own testing and to implement the protocols that they had created together. They provided the correctional facilities with the testing materials and established a delivery system for NRHD to give them the testing supplies and PPE and a way for the facilities to get the tests to NRHD to be sent off to the lab for quick results.

Hannah and the NRHD staff maintained communication with the correctional facility staff to determine effectiveness and to provide guidance for any positive cases that entered the facility. Throughout the process, they constantly re-evaluated and adjusted the protocol as the needs changed. 

The outcomes of Hannah’s project were that the mitigation protocols that were created together with the facilities’ staff seemed to be quite effective with preventing serious outbreaks from occurring within these facilities. They were able to provide two types of tests, PCR and antigen. As of November 25, 2020, the team had provided the three correctional facilities with 1,074 rapid antigen tests and over double that amount of PCR tests. 

Hannah felt that the most important outcome of the project was that the relationship between the NRHD and the correctional facilities was strengthened, which is important in combating not only COVID-19 but any future infectious diseases that may arise.

Hannah’s PHPE did not stop with COVID. She also got to be a part of the NRHD’s dream team of students to complete testing at long-term care and substance rehabilitation facilities. She worked with the Virginia Harm Reduction Coalition to do antigen testing, she worked with the Empowered Options Project within the NRHD, and had the opportunity to work with an interdisciplinary team to develop the TransparanSee clear mask. Hannah is thankful for the opportunity she had to obtain such a tremendous amount of public health exposure throughout her PHPE.

Laura York collaborated with the Virginia Tech Institute for Policy and Governance and the Virginia Tech Center for Public Health Practice and Research on The Connection to Care Project (C2C), which seeks to connect evidence-based practices in order to identify the critical junctures at which persons with substance use or opioid use disorders will seek treatment for her PHPE. This project is targeted in the Roanoke Valley, which has been identified as a Comprehensive Harm Reduction locality under the Virginia Department of Health. The C2C project is a multi-level stakeholder intervention strategy that uses crisis response units and provides backpacks with lifesaving tools to address the project goals and objectives. 

The C2C project goals include timely referral of persons experiencing overdose or other substance use health-related crises to connect them with a crisis response unit that will then connect them to appropriate treatment programs to overall see a reduction in overdoses and relapse in the Roanoke area. 

Laura’s PHPE-specific goals and objectives included demonstrating proficiency in quantitative and qualitative data collection, data entry, and data analysis; performing effectively on a multidisciplinary team with Institute for Policy and Governance, Public Health Center for Practice and Research, and Community partners in the New River and Roanoke Valleys; and to serve as a public health education resource for community services that are related to the C2C project. 

Cohorts one, two, and three of the C2C Backpack included lifesaving items such as personal care items like mobile phone power banks, hygiene kits, mask and sanitizer, and specific winter items. They included naloxone and harm reduction items like naloxone and needle disposal container boxes and administrative items such as printed instructions for naloxone use and a brief assessment and survey on the backpack itself. 

The team has now also created a “backpack lite,” which is a smaller version of the C2C backpack and includes items like hand sanitizer, a mask, water bottle, and the C2C referral card. The C2C referral card is attached in every backpack as well as distributed to the general public and includes information on how to access Narcan as well as some of our partner-in-crisis response unit agency information for a quick referral. 

The methods of this project included:

• HOPE Initiative and Virginia Harm Reduction Coalition Interagency Crisis Response and Prevention through peer recovery specialists and management services and those supports
• specific C2C products, which are the referral cards and backpacks
• development of the partner delivery network
• conduction of outcome and process evaluation (Laura participated the most with this aspect)
• an evaluation of the current referral sources in the area

Laura sent a process evaluation survey to 50 program stakeholders to assess the overall feedback, successes, challenges, and satisfaction of the usefulness of certain project components. Responses were laid out in a document with the question, number of responses, and a short description. Process evaluation interviews were conducted with 14 key stakeholders to assess some of those same components as the survey but also some things like priorities for assisting continuation. Responses were analyzed for common themes and reported. 

In conclusion, the C2C project mainly focuses target persons in active substance use and connects them with treatment options and overall promotes a healthy lifestyle. Specifically, the process evaluation of Laura’s project seeks to improve the processes of implementation of the project and improve those project outcomes. Her recommendations for future work with this project include application for new grant cycles, distribution of more backpacks, a year-two stakeholder survey and analysis, and evaluation of the year-one grant cycle. 

Teagan Neveldine serves as a peer-health educator with Hokie Wellness, where she worked with her supervisor, Jon Fritsch, to create a new educational vaping workshop in response to the growing epidemic of e-cigarette use among youth for her PHPE.

Teagan’s research revealed that, according to the most recent National Youth Tobacco Survey, about one in five high schoolers and one in 20 middle schoolers were current e-cigarette users. Although these numbers reflect a decline in current e-cigarette use since 2019, 3.6 million US youths still currently use e-cigarettes in 2020, which indicates a strong nicotine dependency among youth. Teagan felt that it’s not surprising, then, that we’re seeing an increase in e-cigarette use among college students. 

Teagan noted that, according to the National College Health Assessment, current e-cigarette use among Virginia Tech students more than tripled from 2016 to 2018. These rates will likely continue to increase with national trends. Teagan’s goals were to identify some of the potential negative impacts vaping could have on students’ physical, mental, and emotional health; explain the current societal and cultural factors that influence youth vaping habits; and provide tobacco cessation resources that are available to students, both on and off campus.

In order to engage students with this information, Teaagn and Jon developed and implemented a one-hour-and-fifteen-minute virtual Healthy Hokie workshop for Virginia Tech students, taught over the Zoom platform. Much like the other programs that are offered by Hokie Wellness, the vaping workshop was shared on Hokie Wellness’ social media platforms and offered as academic credit for select courses. The workshop was facilitated by the Health Education and Awareness Team, which is a group of trained peer health educators who teach workshops on a range of different health topics. 

Teagan and Jon designed the workshop in a way that encouraged participation and kept students engaged through a series of chatting questions and polls. One educational point they highlighted was that vaping isn’t just harmless water vapor. It’s actually an aerosol that contains ingredients that are known to be harmful or potentially harmful to e-cigarette users. Another point was that research is just starting to show the health impacts of vaping, but it’s not clear yet what the long-term health effects are. They emphasized that it took many decades to understand the toxicity of cigarettes, and we’re still discovering new ways in which they harm our health. Lastly, they discussed that loopholes in policies have left the newer disposable vaping devices like Puff Bar without regulation, since they aren’t subject to the new federal policy regulating flavored e-cigarettes. This is especially concerning, since disposable e-cigarette use increased approximately 1000% among current high school e-cig users from 2019 to 2020. To add to the health effects of vaping, a recent study found that youth that vape are five times more likely to contract COVID-19 compared to their peers who don’t vape. Youth are also four times more likely to go on to smoke combustible cigarettes that are more harmful than toxic nicotine products. 

Teagan and Jon listed some of the quitting resources that Virginia Tech offers for students. Since they tend to get overlooked, the team covered them both during the workshop and included them in the e-portfolio that they sent to participants after the workshop with additional resources, such as appointments with a certified tobacco treatment specialist, a free trial of quitting medicines, and reduced-cost nicotine-replacement therapies. 

Some of Teagan’s takeaways from the experience included the challenging process of designing an inclusive program that everyone can benefit from, including people who vape regularly or occasionally, people who are thinking about vaping, and even those who never plan to vape at all. Teagan and Jon were happy to hear feedback from students that they liked the online format and felt that it was easier to participate virtually. Finally, Teagan learned that facilitators may require additional resources and training to have more confidence in their understanding of the nicotine-addiction process in order to competently convey information when leading vaping workshops. 

Looking ahead to the next steps of this program, Teagan would like to evaluate changes in students’ understanding of the health effects of vaping, their attitudes about vaping, and their intent to implement strategies and behaviors that either initiate the cessation process or prevent the start and continued use of vaping devices.

Emily Emerson completed a PHPE on smoking cessation in North Macedonia in collaboration with LinkAcross in North Macedonia and the Institute of Public Health. 

North Macedonia has a high prevalence of smoking and very little smoking regulation. Through research of programs that have worked in other countries, Emily found that typically behavioral therapies combined with nicotine replacement therapies are the most effective. However, there has recently been a big push for electronic or texting behavioral therapies that are proving to be just as effective, if not more so, because of their on-the-move aspect. 

Emily’s objectives with this project were to dig deeper into the research process and learn how to better apply the material she was researching, to work with community members and organizations to determine the community’s needs, learn the ins and outs of survey administration and evaluation, and to work with global organizations to determine if she had a larger interest in global public health as a career. 

Much was accomplished with this project as a whole, but Emily personally worked on the consent form, which was placed above the survey to be read prior to completion. She also worked on the literature review. Before she could complete the work on her portion of the project, the IRB and the survey had to be completed. Additionally, Emily created the recruitment materials that would be used to promote and advertise the survey on social media platforms. For the literature review, she utilized the databases that are provided through the Virginia Tech library to focus on the types of programs for smoking cessation that have been completed across the world. 

The consent form informed those who were interested in completing the survey how the data was going to be collected and used. It helped the researchers identify and address the population in need. Lastly, it allowed for the research team to discover at what level of readiness the majority of the population was at with regard to quitting smoking. 

The literature review allowed Emily to implement procedures utilized in other MPH courses and to better hone her research skills. The literature review also identified important program components that would be pertinent to include in the program implemented by North Macedonia. 

Throughout this project, Emily learned a great deal about cultural competency and how important it is to be culturally aware when doing public health work in a global setting. She was able to further realize the importance of research in public health and its role in writing literature reviews as well as other research components. Some further work with this project Emily identified would be to create a program and evaluation plan for a mobile smoking program to be implemented in North Macedonia.

For her PHPE, Becky Willis worked on the Substance Use Disorder Stigma Reduction Project with the Virginia Tech Center for Public Health Practice and Research. 

Becky reported that stigma and discrimination toward those who use opioids has made confronting and healing from addiction difficult. Finding effective and appropriate ways to understand and communicate with populations affected by opioid abuse is critical in lessening its burden and decreasing harmful stigma. Her project aimed to find effective ways to communicate with these populations and destigmatize substance use disorder. 

Becky’s deliverables for this project included an in-depth literature review as well as stakeholder interviews. She has continued to work on this project conducting further data analysis. Becky’s three main objectives were to collect primary and secondary data to inform substance use disorder messaging and materials development, to synthesize findings from literature review and primary data collection and develop draft messages and materials for various communication channels, and to identify appropriate communication channels for a regional campaign to reduce stigma related to substance misuse and addiction. 

Becky’s first step in the methods for her project was to conduct an in-depth review of peer-reviewed and grey literature. Her peer-reviewed literature search consisted of information regarding substance-use disorder stigma and related issues. Her grey literature review looked at existing substance use disorder and opioid messaging campaigns in multiple southeastern states and in national organizations like CDC and SAMHSA.

Next, Becky and the team she worked with collected primary data through stakeholder interviews in Virginia Community Service Board Region 3, which is located in southwest Virginia. These interviews included both individuals who regularly work or interact with individuals with substance use disorder and personal stories from people in stable recovery. Key stakeholders were community service board directors, local health department directors, healthcare providers, law enforcement representatives, judges and justices, family members of people with substance use disorder, peer recovery support specialists, public school staff, community members, and individuals in recovery. 

Next, Becky and the team synthesized data in a preliminary theme analysis and created an initial messaging campaign. They further analyzed and interpreted data to find common themes among stakeholder interviews. 

After primary and secondary data collection, the team identified common themes across the literature reviews and the stakeholder interviews, including a lack of both public and professional education on substance use disorder, stigma, judgement, and neglect surrounding substance use disorder to negatively affect treatment and health outcomes. Substance use disorder is not a choice but rather a mental health issue that can be treated. Stigma creates multi-level barriers to care, and sympathetic personal narratives can be highly effective in both education and messaging campaigns. 

Using what they found in their preliminary analysis, Becky and her team created temporary messaging that focused on a personal story of addiction and recovery. Overall, they found that the most successful substance use disorder interventions and messaging campaigns included personal stories of individuals in recovery and work to destigmatize addiction in everyday life. Connection, understanding, and de-isolation were common themes found in interviews conducted with people in recovery and were integrated into the temporary messaging deliverables.

As for next steps, an in-depth data analysis and interpretation will be conducted to determine common themes in stakeholder interviews to inform future messaging campaigns and to guide recommendations for supplemental project development and use. Becky and her team members are currently creating a thematic coding matrix using an inductive reasoning approach to find correlational associations and identify unique experiences, beliefs, knowledge, and responses within stakeholder interviews.

Marya Hubbard’s PHPE focused on North Macedonia readiness for smoking cessation. Macedonia is slightly larger than Vermont, and it’s smoking rate is about 37%. For a population of 2 million people, this is concerning, as lung cancer is the most commonly seen form of cancer in the country. These factors led to a partnership between a nonprofit known as LinkAcross Macedonia, Virginia Tech, and the Institute of Public Health of the Republic of North Macedonia to help determine the readiness for change among the population. 

Marya and the team she worked with set overall objectives for the project, including determining the readiness to quit smoking, developing a smoking cessation program based on the transtheoretical model of change, delivering an electronic survey, and decreasing the smoking rate among the North Macedonian population. The methods used in achieving those objectives were creation of a survey to determine the basic demographics and smoking status, completion of the IRB application, and translation of the survey into the Macedonian language from English. 

Marya and the team used the five stages of the transtheoretical model to create their questions. Examples of questions developed included, “Do you have any intention to quit smoking in the next six months?”, “Do you plan to quit smoking within the next 30 days?”, and “Have you been smoke-free for six months or more?” They also included questions to determine education level, smoking history, and the perspective from the survey participants on how well smoking regulations have been implemented within the country over the past few years. 

The team consisted of students, a medical doctor, an engineer, public health professors, and the head of the Department for Health Promotion and Monitoring of Disease at the Institute of Public Health, resulting in a tremendous amount of interprofessional collaboration to form a culturally appropriate survey for the country. The survey was about to be released at the time of this writing. Marya had hopes for high participation because of the collaborations they were able to maintain, and she felt confident that this survey would result in a better sense of a direction for development of a community-based program. 

Marya suggested that future work with this project could include analyzing the data, forming a program that fits the demands, and then establishing an evaluation plan for the overall program. 

Marya reported having learned the importance of partnerships with multiple organizations to reach more people internationally. She felt that if they had only collaborated with LinkedAcross, their population reach would’ve been smaller. She also learned that flexibility is a necessity, as the products, goals, and direction of their project changed multiple times throughout her PHPE experience. Another learning process was receiving feedback on changes needed on the survey to make it more culturally acceptable. It also allowed her to better understand and apply cultural competence and to grow her communication skills and knowledge of designing a public health program.

For Grace Zhang’s PHPE, she conducted a telemedicine needs assessment for the Veterinary Teaching Hospital’s Community Practice Department, also known as CPRAC. The goal of her project was to assess CPRAC’s clients’ attitudes toward telemedicine as part of their pets’ veterinary care.

In the last several years, using telemedicine in veterinary medicine has become more common, but it’s not been a formalized or standardized practice in the industry. Finding out what pet owners think of and how they use telemedicine could be useful to develop best practices for veterinary professionals. 

The COVID pandemic and related restrictions have caused a spike in interest in veterinary telemedicine, because it’s a supplemental way to provide needed vet care. Based on her research, Texas A&M’s veterinary teaching hospital was the only academic veterinary teaching hospital that offered virtual telemedicine visits for companion animal care until last spring. In May of this year, Dr. Virginia Corrigan started offering virtual visits for CPRAC’s clients at Virginia-Maryland’s teaching hospital. 

Since Dr. Corrigan was starting virtual visits at CPRAC, which sees companion animals for residents in a 35-mile radius of the teaching hospital, Grace conducted her needs assessment of those clients and limited it to people who had brought their pets to CPRAC in the last year. She created an 18-question Qualtrics survey that was emailed to 944 CPRAC clients. In over one month, she received 125 responses that were over 50% complete. 

Survey respondents were from a variety of age groups and the majority were women. At the end of her survey, Grace requested that those who would be interested in being part of a focus group provide their name and contact information. Thirty-one people did, and 14 of them participated in one-hour Zoom meetings that Grace moderated with prepared questions. 

Initial analysis of the survey data showed that most respondents like aspects of telemedicine for their pets’ veterinary care, including video calls with the vet techs, emails, online scheduling, and synchronous virtual appointments (meaning that the owner can participate in the appointment virtually while waiting outside of the clinic during their pets visit with the vet). Most respondents who reported having an excellent telemedicine experience for their own health were also more likely to use veterinary telemedicine in the future. More clients attributed convenience as their main reason for using telemedicine for their pets’ care. Regardless of the number of pets and the clients’ age, most people reported that they would be likely to use telemedicine for their pets’ care in the future. 

Grace found that survey data and general themes from focus groups indicate that CPRAC clients are in favor of using telemedicine for their pets’ care, mainly because of convenience. However, people expressed some concerns, such as not knowing when a problem is an emergency or not being confident in relaying the appropriate information to the vet via a virtual medium, and having follow-up questions that didn’t come up in the appointment. 

As a result of this survey, Grace made three recommendations. First, she suggested that the veterinary teaching hospital at Virginia-Maryland explore and invest in their telemedicine services, because it is a service that clients want and would use. Second, they should use telemedicine appointment exit surveys to figure out what works and what can be improved. And third, they should consider adding telemedicine into the veterinary school’s curriculum, because veterinary telemedicine is likely to be used more and more. 

Grace felt that future directions for this project could include further data analysis including a multivariate analysis and creating a multi-department or institutional study for better generalizability. 

Emily Hardgrove completed her PHPE on the surveillance and risk factors associated with the dissemination of West Nile Virus in equines and mosquitoes in northeast Brazil. Emily’s preceptor, Dr. Deem, is from the St. Louis Zoo Institute for Conservation Medicine and has partnered with colleagues at the Federal University of Piaui to conduct arbovirus surveillance work in Brazil. As evidence of West Nile Virus exposure is spreading in Brazil, the importance of increasing surveillance coverage and awareness among veterinarians and environmentalists is imperative for the early detection of cases and needed to treat individual animals and prevent possible outbreaks. Furthermore, sharing this research with local communities is needed to promote environmental, animal, and public health. 

The objectives of Emily’s project were to identify and evaluate the temporal and spatial dynamics of West Nile Virus in Piaui, Brazil, and to assess applicable modeling approaches. Next, she wanted to use this to model West Nile Virus risk factors to create heat maps for Piaui, Brazil. She also wanted to create outreach material to communicate research and educate local communities on best practices to recognize and reduce the risk of West Nile Virus. 

Emily’s deliverables included making educational pamphlets. Her methods for this were designing brochures for veterinarians, public health officials, and community members. She also worked to create material for school activities. 

Another deliverable was developing a knowledge-attitude-practice survey that could be used to determine how efficacious educational material was at informing communities about West Nile Virus. This could be used to guide future field methods and educational efforts. 

Lastly, Emily wrote code to download satellite imagery data from Google Earth engine. She  developed a risk map in ArcGIS Pro using this imagery and data. In order to make this more accessible, she built a web application that can be used to visualize and evaluate where certain areas in Piaui, Brazil, were more at risk and what variables had different levels of impact as well as what areas were more diverse and potentially could be sites for additional sampling for West Nile Virus, because not a lot is known about the epidemiology in Piaui. 

The outcomes of Emily’s project were, first, a literature review of the land cover, hydrology, and climate variables most likely to impact the risk of West Nile Virus in Piaui, Brazil. As an arbovirus, these factors are highly locally specific, and it’s important to understand what factors are most impactful in a certain area. Emily also assessed the most applicable models, statistics, and remote sensing satellite data sources that could be used. She used this to make a workflow with ArcGIS Pro software to introduce environmental modeling to West Nile Virus disease surveillance. With her educational material, Emily built a foundation for future surveys to assess the efficacy of such material. These materials began to be distributed during field visits. 

Emily learned a lot during this project. Even though it was remote, she was able to gain cross-cultural and multilingual infectious disease education and communication skills. She learned how to evaluate the significance of various risk factors for infectious disease transmission and use these to inform how to best select models given available literature and data on infectious disease. She felt that this would help her in the future design research projects in terms of knowing what data she needs to collect and what is needed for different models. Furthermore, she reported being excited to see how this model design and implications will inform future disease surveillance.

Shawn Kozlov completed his PHPE with the US Department of Agriculture Import/Export Group, helping build a Registered Aquaculture Export Facility master list and training webinar. 

Aquatic export for the United States has been steadily increasing over the last few years, and there is an increased effort in the USDA to standardized how those facilities are inspected, with an emphasis on infectious disease control and biosecurity, and a desire to put together a list of registered facilities that are inspected specifically to export certain species to certain countries.

The objective of Shawn’s PHPE was to help build a master list that would be easily searchable by all those involved, including the field veterinary medical officers, the service centers for the USDA that service those regions, the export officers who work directly with the export countries and what requirements they might have or want, and the import/export aquatic specialist at the USDA, who is heading up the registered aquaculture export facility changes. Shawn developed a master list that can be accessed as well as a training webinar for the field veterinarians focused on how infectious disease spreads in aquaculture facilities, what are the important red flags, how that population health should be managed, and what they should be looking for, especially as it involves water and the way water moves through the facilities. 

For his first deliverable, Shawn took their previous master list and standardized the data. It had been combined haphazardly throughout the years, and as that list grew, it became basically unsearchable. Searches had to be done manually. By standardizing the information and building pivot tables, Shawn made it easily accessible. With a few clicks, users can see what state, what facility, what species, and to what country each facility has been inspected to send that species. It highlights the date in green if it’s good or red if it is expired. The information in the backend is also easily searchable in other ways so that the export officers can search in an easily managed operation. The first deliverable was a data management system that is now shared on a sharepoint drive and functioning well. 

The second part of Shawn’s project utilized a bit more of the public health and infectious disease focus. He looked at how disease transmission occurs within an aquaculture facility. A lot of that focus was on water, as it’s very different from how a disease might transmit through a cattle farm or a poultry facility. Shawn developed education for the veterinary medical officers in the field on what the red flags were and what disease transmission pathways they should be focused on for aquaculture medicine. 

Because most veterinarians aren’t given a robust training in aquaculture medicine or disease transmission, Shawn felt it was important to highlight population health infectious disease biosecurity in the training so veterinarians know how to adequately inspect these facilities. The USDA can back them up on that and feel good about sending this aquaculture product to other countries.  

Shawn reported that everything seems to be working really well. The program was launched at the end of August, and the training for the program was held in early September. The feedback he received from his preceptor, Dr. Marston, is that everything went really well. The field veterinarians feel confident in their ability to do these inspections, and they understand the importance of the vectors and fomites for disease transmission in an aquaculture facility and how that differs from your typical dairy or poultry facility. 

The master list has also been working well. The service centers report being able to find information quickly and easily, and Dr. Marston has been able to develop additional reports off of the standardized data for others in the USDA to use to make decisions.

For her PHPE, Lizzie Rives, created animal shelter infectious disease protocols for the Middleburg Humane Foundation (MHF). 

The MHF sees a variety of small animals, ruminates, and equids. They intake animals on a regular basis and need protocols in place to prevent the spread of infectious diseases. Lizzie focused on several pathogens that can infect dogs, cats, and horses and developed educational companion animal documents for MHF/s foster-adopter network. She focused on parvovirus, feline herpes virus 1, calicivirus, tapeworm pathogens, and Echinococcus multilocularis as well as several equine viruses. 

Lizzie’s objectives were as follows: to create a needs assessment for standard operating procedures and foster handouts; to investigate common behavioral problems, contagious diseases, and minor medical issues faced by fosters and adopters; to develop biosecurity recommendations for infection control and prevention for cats, dogs, and horses; to describe pathogens, transmission, symptoms, zoonotic risk, and proper prevention of diseases; and to develop foster and adopter educational resources. 

To start this project, Lizzie first researched primary literature surrounding shelter medicine. Once she developed draft protocols for MHF, they were reviewed by professionals in the veterinary field, including MHF veterinarian, Dr. Loonam. Lizzie then presented her documents to MHF personnel to ensure that they were pleased with the results. 

Over the course of the summer, Lizzie created four infectious disease protocols, one foster-adopter handout totaling 16 pages for newly adopted pets, and one equine vaccination guide totaling 15 pages. In these documents, she highlighted the importance of proper tapeworm prevention and how it impacts human health. 

Echinococcus multilocularis is a tapeworm species that she focused on for her PHPE. It is ordinarily found in wild canids, including foxes, coyotes, and other wolves. The parasite has also been identified in domestic dogs, more rarely in cats, and potentially is a serious public health concern by involving humans as accidental intermediate hosts. 

Recently, a companion canine in northern Virginia was found to be infected with Echinococcus multilocularis. The adult tapeworm is small and resides in the intestinal tract of the host, which is wild or domestic canid. Eggs from the adult tapeworm that are shed in the feces of the infected canid and rodents, such as mice and voles, serve as the intermediate host for the Echinococcus multilocularis. Eggs ingested by rodents develop in the liver, lungs, and other organs to form multilocular cysts. 

The life cycle is completed after a canid consumes a rodent infected with a cyst. After ingestion of the infected rodent, larvae within the cyst develop to adult tapeworms in the intestinal tract of the canid and eggs are passed approximately 28 days later. This parasite poses a serious public health problem because of the possibility for human involvement in the life cycle. 

If the eggs shed by an infected canid are accidentally ingested, a highly pathogenic condition called alveolar echinococcosis results from the development of the cyst stage in humans. People at high risk include trappers, hunters, veterinarians, and others who have contact with wild foxes or coyotes, and household dogs and cats that have the opportunity to eat wild rodents infected with Echinococcus multilocularis. Humans can be exposed to these eggs by hand-to-mouth transfer of contamination. 

Domestic dogs living in Echinococcus multilocularis endemic regions that roam freely with the opportunity to catch wild rodents are at risk for infection. Because the tapeworm may now be endemic in this region, Lizzie advised that animals entering the MHF should be dewormed with Praziquantel to reduce the risk of Echinococcus multilocularis transmission. Dogs infected with Echinococcus multilocularis should be treated to prevent exposure of humans to infected eggs and reduce the perpetuation of the parasite’s life cycle. 

Cases have been reported worldwide and include central Europe, Russia, China, central Asia, Japan, and North America. In North America, Echinococcus multilocularis is found primarily in the north-central region from eastern Montana to central Ohio. It was most recently found in northern Virginia, which is why it is of utmost importance that owners and animal shelters use proper prevention methods for Echinococcus multilocularis and use a deworming product like Praziquantel.

Alveolar echinococcosis is caused by tumor-like tapeworm larvae growing in the body. Alveolar echinococcosis usually involves the liver but can spread to other organs in the body, and because they are slow growing, it can be very slow for symptoms to occur, but it is very serious when they do, because it can result in death. 

For future work, Lizzie stated that she would like to continue educating animal shelter volunteers and staff. She would also enjoy implementing biosecurity protocols and handling for pocket pets at MHF, as they’ve seen an increase in rabbits. Finally, she would love to create an outbreak infection control system for employees and volunteers at MHF like the color-coding system that is currently in the Virginia-Maryland Veterinary Teaching Hospital.

Many exotic animal species are not suited, whether by size, temperament, or nature, to handling for diagnostic testing when they fall ill. As a result, veterinarians often rely on minimally invasive techniques to assess their health status. These techniques can include imaging as well as analysis as blood analytes. 

Uric acid is one such blood anolyte that can be measured in reptilian blood. It’s sometimes used in reptiles as a proxy for renal health, because most reptilian nitrogenous wastes are excreted as uric acid through the kidneys. Hyperuricemia, or high uric acid, is therefore thought to be associated with loss of functional renal mass and subsequent failure to excrete uric acid. However, there are multiple other factors that can cause uric acid to become elevated, such as high-protein diets, gout, or carnivory. Overall, uric acid is considered neither sensitive nor specific for renal disease, and the multiple causes of hyperuricemia mean that uric acid is not a good predictor of renal disease, at least clinically. However, it is frequently used as a proxy for renal health due to lack of superior alternative blood analytes for predicting renal diseases. 

Elizabeth’s PHPE aimed to evaluate the clinical diagnostic utility of uric acid in a captive population at the National Aquarium in Baltimore. She first performed a literature search on the topic of uric acid within Agamidae, then she obtained necropsy reports, which are writeups of post-mortem examinations, from the performed necropsies and have records from the National Aquarium. Those records were used to sort eligible patients into two broad categories, those with renal pathology and those without renal pathology. 

Following this, Elizabeth back searched the National Aquarium medical record system to obtain the most recent pre-mortem UA and a picture of the animal’s clinical status antemortem, i.e., were they a sick animal before they died or were they a healthy animal? Were they being treated for renal disease or not? These values were all then compiled and analyzed, and she ultimately gathered additional data on potential other renal analytes for preliminary analysis. 

Elizabeth’s key findings were that uric acid greater than 5 mg/dL, a cutoff determined based on literature searches and National Aquarium in Baltimore veterinary and clinical experience, is not a reliable predictor of postmortem changes at necropsy. However, uric acid did differ with renal changes at necropsy when controlling for species. 

This was determined with a two-way ANOVA to check for the impact of species on postmortem diagnosis of renal changes. Elizabeth found no statistical evidence that the effect of postmortem changes was different for different species or that UA differed as a function of species, but it did differ as a function of renal change at necropsy. Elizabeth noted that the clinical utility of that finding is limited, though. 

The UA distributions overlap heavily between the two populations, and it’s inappropriate to extrapolate from population data to the individual animal in the clinical setting, given the way that Elizabeth conducted this project. She did look at other blood work analytes as possible indicators of renal change, but only albumin was significantly different between animals with renal changes and those without, once corrected for species. As albumin has low biological specificity, its clinical usefulness as an indicator of renal disease is really poor, at best.

Elizabeth also did an examination of other causes of elevated UA based on animal’s medical records that may have included inflammatory changes in the bloodwork, which is a potential and worthwhile topic of future study in this area. 

Overall, Elizabeth’s findings were consistent with the literature, that uric acid is not a good predictor of renal disease, and it should not be used as the predictor or the thing that you diagnose renal disease based on if you are a reptile veterinarian.