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Program faculty present research and practice at the virtual APHA 2020 Annual Meeting

The American Public Health Association (APHA) 2020 Annual Meeting and Expo was held virtually from October 24 to 28. The  2020 theme was Creating the Healthiest Nation: Preventing Violence. Program faculty presented their research and practice through online live presentations and recorded poster presentations. You can read about each presentation by clicking on the tabs below. 

Gwendolyn Francavillo, PhD, MPH, CHES, RYT, Department of Health and Human Performance, Marymount University, Arlington, VA and Lisa M Lee, PhD, MA, MS, Scholarly Integrity & Research Compliance, Virginia Tech, Blacksburg, VA

The Principles of the Ethical Practice of Public Health is the code of ethics developed by the Public Health Leadership Society in response to historical exploitations of vulnerable communities in Public Health programming and research. Public Health activities that align with the code assure vulnerable or marginalized communities have a voice, receiving the services they need ethically and confidentially.

The Opioid Learning Institute provides comprehensive, accredited, community-informed and evidence-based workforce education for prescribers and other healthcare professionals on safe and effective opioid prescribing practices, treatment options for opioid use disorders, harm reduction strategies, and both prevention and reversal of opioid overdose. The Institute was developed in response to the nationwide opioid epidemic in order to provide workforce development for prescribers and other health professionals who lack the training to adequately meet patient need for pain management, particularly patients with opioid use disorder.

In this session, we will explore the process of the development of the Opioid Institute beginning with the identification and engagement of national experts, local providers, community health workers, and community members. We will discuss the various methods in which the Institute ensured alignment with the Ethical Principles of the Practice of Public Health in the development of eLearning content, resources, and activities.

Mira Nicchitta, BS, Virginia Tech Carilion School of Medicine, Roanoke, VA, Charlotte Baker, DrPH, MPH, CPH, Virginia Tech, Blacksburg, VA and Mandy Atkinson, MD, Carilion Clinic, Roanoke, VA

Background: Long-term Sickle Cell Disease (SCD) care has been improved with comprehensive SCD clinics that provide pediatric-to-adult care. However, no such clinic exists in Southwest Virginia (SWVA), and patients must transition care from pediatric to adult clinics in young adulthood. While pediatric clinics will follow patients into their early 20s, this leaves young adult patients particularly vulnerable to care lapses that can increase disease-related morbidity and mortality. The purpose of this study was to characterize acute SCD-related complications and ED utilization in patients in SWVA without access to a comprehensive SCD clinic.

Methods: 71 patients between the ages of 8-42 years who received care at a regional hospital system were identified using ICD-10-CM diagnosis codes for SCD. Descriptive statistics and nonparametric testing were used to evaluate differences in incident acute pain crises and ED utilization.

Results: Among Medicare (n=11, mean age 33), Medicaid (n=42, mean age 23), commercial (n=10, mean age 23), and self-pay (n<10, mean age 21) patients, there was a statistically significant difference in ED-to-inpatient visits with Medicare patients exhibiting a higher median number of ED-to-inpatient but not ED-only encounters. Compared to Medicaid patients, Medicare patients had a higher median number of ED-to-inpatient visits, but there was no statistical difference in median acute pain crises.

Conclusion: Medicare patients, the non-pediatric care population for this cohort, presented with more severe disease-related complications requiring hospital admission compared to Medicaid, commercially-insured, and self-pay patients. Implementation of transition-of-care programs, designated SCD adult hematology providers, and patient education could close this care gap.

Kerry Redican, MPH, PhD, CHES, Virginia Tech, Blacksburg, VA, David Sallee, PhD, Radford University, Radford, VA, Nancy Hans, MS, Prevention Council of Roanoke County, Roanoke, VA and Rachel Silverman, PhD, ScM, Virginia Tech, Blacksburg, VA

Background: Roanoke County Schools in Southwest Virginia in partnership with the Prevention Council of Roanoke County have been conducting youth risk behavior surveys (YRBS) administered to all students in grades 6-12 (n=7,000+/yr) for the past 20 years (10 administrations, 67,000+ students).

Methods: Since 2006, fifteen questions focused on school and home violence were incorporated into the Roanoke County YRBS. Descriptive statistics and Odds Ratios were calculated.

Results (selected): This presentation will focus on trend data for each of the violence-related questions and odds ratios between violence-related questions and: (1) substance use; (2) suicide ideation; and (3) bullying. For example, In 2018, among Roanoke County High School students; 11.4% (21.3% in 2016) did not go to school because they felt unsafe; 17.1% (18.7% in 2016) were in a physical fight one or more times during the past 12 months (18.7% in 2016); 21.1% (20% in 2016) reported being physically harmed by someone in their home. In addition, in 2018, students that reported during the past 30 days, they did not go to school because they felt unsafe were: 3.4 times more likely to report attempting suicide in the past 12 months; 2.8 times more likely to report binge drinking (5 or more in a couple of hours) in the past 30 days; and 4.4 times more likely to report being in a physical fight in the past 12 months.

Application: YRBS results were used to identify programs and strategies to reduce violence related behaviors. These programs and strategies will be presented and discussed.

Sophie Wenzel, MPH, DrPH, Hannah Menefee, MPH and Laura Hungerford, DVM, MPH, PhD, CPH, Virginia Tech, Blacksburg, VA

There is an emphasis, nationally, for MPH graduates to have strong teamwork skills, interprofessional acumen, and practice experience when entering the workforce. The Virginia Tech (VT) Public Health Program revised their MPH culminating experience in 2019 to a team- and practice-based Integrative Learning Experience (ILE). The new VT-ILE approach has been tested with three cohorts of MPH or DVM/MPH students.

In the new ILE, MPH students work alongside community stakeholders on a predefined project to collaboratively develop and deliver products that are useful to the community. Products are varied and can include surveys, needs assessments, grants, educational materials, and evaluation reports. Proposals for ILE projects are solicited from a wide list of community stakeholders and then students are matched into 2-4 member project teams according to their academic and professional interests. Each team completes a detailed work plan that is signed by the stakeholder mentor, a faculty mentor, each team member, and the ILE instructor.

Although team-work is required, each student is ultimately responsible for an individual written deliverable that contributes to the overall project and demonstrates three program competencies (at least one foundational and one concentration-specific competency). Student performance is assessed based on this individual deliverable (40%); a team presentation (20%); and individual assessment by: the faculty mentor (10%), the stakeholder mentor (10%) and by their team-mates (10%). Students also complete a two-page reflection after completing their ILE, incorporating thoughts on their role and performance on the team, how well they communicated, and how they maintained a climate of mutual respect and shared values (10%).

The new ILE allows students to apply creative, practice-informed solutions to real-world public health problems, helping them develop necessary readiness skills for future application to the workplace. It also strengthens ties between the university public health program and the communities we serve.

Robin Lemaire, PhD, Virginia Tech, Blacksburg, VA, Sophie Wenzel, MPH, DrPH, Virginia Tech, Blacksburg, VA, Donna Sedgwick, PhD, Virginia Tech, Blacksburg, VA, Charlotte Baker, DrPH, MPH, CPH, Virginia Tech, Blacksburg, VA, Jeff Dinger, Giles County, Pearisburg, VA and Chris McKlarney, Giles County, Pearisburg, VA

Local governments are faced with dwindling public funds for services and escalating costs as a result of reactive approaches to violence and health. One county government in rural southwest Virginia used Geographic Information System (GIS) to analyze crime related data to realize that 5% of the physical locations in the county used 56% of all reactive services. They launched Focusing on communities utilizing services (FOCUS), a citizen-centered network approach to intervening in five neighborhoods to decrease violence and improve health.

We examined FOCUS after the intervention in two neighborhoods and documented the launching of the process in a third neighborhood. Our research employs small-N statistical analysis to assess change in the use of reactive services over time for each neighborhood, network analysis and interviews to examine the way service providers work together to implement the project, and observations to document the process of resident engagement.

Preliminary results indicate FOCUS has resulted in a decrease in 911 calls to law enforcement, as well as other reactive services and has connected residents with a network of service providers for preventative services. Key to its success is its process for engaging residents as well as committed administrators who know how to relate and build trust with the residents and the service providers.

FOCUS is a program that can be disseminated and replicated in other rural counties to prevent violence and improve community health, but having the right community engagement personnel and building a strong network of providers are necessary factors for successful implementation.