Educational Intervention to Increase COVID-19 Vaccine Uptake in Rural Patients with Chronic Diseases: Lessons Learned from An Innovative Academic-Community Partnership.

BACKGROUND: The pandemic has disproportionately impacted rural communities with a higher burden of chronic disease and COVID-19 infection. West Virginia is a rural state with a high rate of diabetes, hypertension, and COPD, which are known risk factors for severe COVID-19 and long COVID. Yet, there is a significant hesitancy regarding COVID-19 vaccination uptake in the state. The purpose of this study was to use an educational intervention to increase vaccine knowledge and vaccine acceptance in rural patients with chronic disease(s) in West Virginia. This project used an academic-community partnership comprised of researchers, practitioners, community organizations, community-engaged partners, and patient stakeholders to increase COVID-19 health literacy and increase vaccine acceptance among rural West Virginians with chronic conditions. MATERIALS AND METHODS: A quasi-experimental study design was used to deliver an educational intervention by trained Health Navigators using short videos to increase COVID-19 health literacy and address participants' vaccine concerns. Eligibility included adults (18 years and older) who have at least one chronic condition. A statewide community advisory board (CAB) guided the development of the educational training curriculum and implementation strategies. An adapted version of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework guided the development of the intervention. Health Navigators (n = 45) delivered the educational intervention in their local communities between November 2022 and October 2023 (project implementation is still ongoing). Intervention fidelity checks, an adaptable script, and a flow chart allowed tailoring of brief videos to address participants' specific COVID-19 questions and vaccine concerns. A validated online survey, monitored by an online Research Electronic Data Capture (REDCap) database, assessed participants' knowledge, perceived susceptibility, and vaccine intention. RESULTS: Health Navigators delivered the intervention to 1368 West Virginians in 52 counties (59.2% women; 61.8% without a college degree). Participants reported living with an average of 2.1 ± 1.4 chronic conditions. The mean age was 43.5 ± 18.8 years. The majority of participants (81.2%) had received the primary vaccination series, and 63.1% had at least one booster. However, 18% were unvaccinated or did not complete the primary COVID-19 vaccine series. Discussions to improve vaccine literacy focused on how the vaccine was so quickly developed and protects against variants, addressing concerns related to the safety, short- and long-term side effects, and importance of vaccine uptake for immunocompromised individuals. Participants with higher concerns were more likely to be unvaccinated and to have not completed their primary series or boosters (p < 0.001). However, the educational intervention improved the willingness of individuals who were either unvaccinated or did not complete their primary vaccine series to get vaccinated (11.4%). DISCUSSION: Our findings highlight the importance of vaccine literacy in increasing vaccination rates among rural patients with chronic diseases. Using the EPIS framework allowed us to reflect upon the challenges, ensure resilience during changing local contexts, and plan and implement a promising, cost-effective intervention in rural areas. CONCLUSIONS: This study provides insights into the need for tailored educational interventions based on disease status, which has implications for public health and patient care in rural and underserved communities. Academic-community partnerships can be useful for successful knowledge transfer for vaccine acceptance to reduce rural health disparities.

Fish in a Dish: Using Zebrafish in Authentic Science Research Experiences for Under-represented High School Students from West Virginia.

Early research experiences positively affect students' interest in STEM careers, and develop practical science and critical thinking skills. However, outreach opportunities are not equally accessible for all students. In states like West Virginia, where many students live in rural Appalachian communities, opportunities for engaging in STEM experiences are limited. In addition, rural teachers may not be equipped to provide authentic research experiences for students due to lack of resources or support. For many students in West Virginia, the Health Sciences and Technology Academy (HSTA) is a major opportunity for STEM engagement. Since its inception in 1998, HSTA has spread to 26 of 55 counties in West Virginia. The program recruits first-generation, low-socioeconomic status, rurally living, and African American high school students who are under-represented in STEM fields. Our research laboratory partnered with HSTA to implement an innovative, hands-on research camp using zebrafish for students participating in their annual junior-level biomedical sciences summer camp. Our camp was held in-person and adapted to an online format during the Covid-19 pandemic. We used pre-post surveys in both camps to assess impacts on science confidence and to collect information about general perceptions of zebrafish, research, and STEM fields. We found that students participating in the in-person and online camps experienced similar overall gains in science confidence. We also identified strong interest in zebrafish, research, and STEM degrees among online students. Online students did not prefer virtual learning experiences; however, they still enjoyed our camp. We also surveyed high school teachers volunteering for HSTA to identify factors that would encourage use of zebrafish in classrooms. The most prominent needs include classroom supplies, experience, and funding. Our successful science-education partnership demonstrates that zebrafish research experiences foster positive outcomes for under-represented students, and can inform future outreach efforts and collaborations with teachers.

Perceptions of West Virginia Teens and Adults Regarding the Risks of Over-the-Counter Pain Medications.

More than 1 billion people live with chronic pain, including 100 million Americans, with a majority utilizing prescription and over-the-counter (OTC) pain medications. OTC medications are readily available and facilitate generally positive efficacy, yet misuse leads to a high number of medication-related problems, with acetaminophen alone accounting for more than 50,000 emergency department visits annually. The West Virginia Health Sciences and Technology Academy (HSTA) high school student program and the West Virginia University Health Sciences Center collaborated to accomplish 2 objectives: to assess and compare knowledge and perceptions of OTC pain medications in the West Virginia community and to develop and provide educational interventions to high school students regarding knowledge and perceptions of OTC pain medications. Resulting student knowledge data illustrated a statistically significant improvement in knowledge. Community survey screening data resulted in 85% answering two-thirds of the knowledge questions incorrectly, with 12% (140 of 1174 participants) answering every single knowledge survey question incorrectly. These data strongly exhibit not only the incredible need for OTC pain medication community education but also that this study's educational methods were very effective at teaching high school students, with possible applicability to the entirety of society.

Diabetes Knowledge, Behaviors, and Perceptions of Risk in Rural West Virginia Counties.

Introduction: A little less than half of American adults have diabetes or pre-diabetes. In 2016, West Virginia (WV) had the highest percentage (15.2%) of adults with diagnosed diabetes in the U.S. Purpose: In partnership with the Health Sciences and Technology Academy (HSTA), a cross-sectional study was preformed to assess knowledge, behaviors, and perceptions of diabetes risk. Methods: Data was collected by trained HSTA students and teachers who lived in rural counties in WV. Information was assessed using validated surveys, and HbA1c was obtained by utilizing professional point-of-care (Bayer) kits. Results: Mean age and Body Mass Index (BMI) was 36.11±17.86 years and 27.80±6.09 kg/m2, respectively. More than half of the participants had a family history of diabetes (58.8%) and hypertension (60.2%), and a majority had elevated BMI (65.9%). However, only 29.2% rated their future risk for diabetes as moderate to high. Eighty percent (80%) had an inadequate amount of weekly exercise, and 36% had lower quality of diet. Overall, dietary quality and diabetes knowledge was associated with a low to moderate diabetes risk score; risk score positively correlated with higher HbA1c (r=0.439, P<.001). Participants' HbA1c, perceived future risk of diabetes and family history of diabetes emerged as significant predictors of diabetes risk in the regression model, controlling for health behavior and diabetes knowledge. Implications: HbA1c, perceived future risk of diabetes and family history of diabetes may be the best predictors of developing diabetes in the future and, therefore, are important to assess during community screening. Perception of diabetes risk is lower than actual diabetes risk in WV.

High School Students' Learning During the COVID-19 Pandemic: Perspectives from Health Sciences and Technology Academy Participants.

This paper examines the perspectives of Health Sciences and Technology Academy (HSTA) participants as they navigate through their West Virginia (WV) high school learning environments (i.e., in-person, blended/hybrid, complete virtual) during the novel coronavirus, SARS-CoV-19 (COVID-19) pandemic. In March of 2020, the participants in this out-of-school-time (OST) academic enrichment program for exceptionally driven, yet underprivileged, at-risk students, with over 70% living in rural areas, started receiving remote learning instruction through learning management systems or via paper packets. In August of 2020, school systems provided parents and caregivers alternative learning environments for their student(s). In order to understand the learning experiences of HSTA students during these unprecedented times, HSTA released the 2020 Learning Outcomes Survey to participants in December of 2020. We performed chi-square test of independence to test the relationship between participants' learning environments, their satisfaction with the education they were receiving, their ability to keep up with their school-work, teacher availability to help when needed and teacher feedback supporting them in their learning environment. The results show significant differences between the learning environments and keeping up with school-work as well as teacher feedback supporting them in their learning; however, Phi and Cramer's V tests for effect size show weak correlations. This study provides a small glimpse into HSTA students' learning experiences as they attempted to continue to learn in their regular school environment during the COVID-19 pandemic while in HSTA.

Cigarette smokers' concurrent use of smokeless tobacco: dual use patterns and nicotine exposure.

BACKGROUND: The concurrent use of cigarettes with other tobacco products, such as smokeless tobacco (SLT), is increasingly common. Extant work with cigarette smokers who also use SLT is based heavily on retrospective reports and between-group comparisons. The purpose of this study was to assess prospectively the patterns of dual users' product use and nicotine exposure on days when cigarettes were smoked exclusively (single use) versus concurrently with SLT (dual use). DESIGN: Forty-six dual cigarette-SLT users recorded their product use in real time via ecological momentary assessment for a 2-week longitudinal design. They responded to questions about situational factors (eg, location, mood) using this same diary, and collected saliva samples each night for later cotinine measurement. At the end of this 2-week period, users reported on their reasons for and beliefs about SLT use. RESULTS: Cotinine levels were significantly higher on dual versus single use days (mean±SEM=374.48±41.08 ng/mL vs 300.17±28.13 ng/mL, respectively; p<0.01), and the number of cigarettes logged was higher on dual versus single use days (11.13±0.98 vs 9.13±1.11, respectively; p<0.01). Product use was distinguished by situational factors, with the strongest predictor being location of use. Moreover, the most common reason for initiating (56.52%) and continuing (67.39%) SLT use was to circumvent indoor smoking restrictions. CONCLUSIONS: Results support the idea of product supplementation rather than replacement among this convenience sample of dual users. For smokers whose primary motivation for SLT use involves situations where they would otherwise be tobacco free, the potential benefits of clean indoor air laws may be diminished.

The Health Sciences and Technology Academy: Re-Imagining Programmatic Delivery During the COVID-19 Pandemic.

Out-of-school time academic/STEM programs provide educational enrichment to a myriad of student populations with some designed to assist those underrepresented and at-risk who desire to purse post-secondary studies. One such program in West Virginia (WV) is the Health Sciences and Technology Academy (HSTA), which provides hands-on, in person and engaging educational enrichment with the intent to increase the college going rates of Appalachia's most vulnerable youth. In March 2020, HSTA key personnel encountered the task of redesigning program delivery due to the immediate shutdown of all in person operations resulting from the novel coronavirus, SARS-CoV-19 (COVID-19) pandemic. This paper discusses the programmatic changes of program delivery during HSTA's key program components-the Summer Institute and the Community Based Programming. This paper also utilizes repeated measures one-way multivariate analysis (MANOVA) and paired t-test analysis to examine participants' perspectives on learning, enjoyment and satisfaction of the aforementioned components prior to and during the COVID-19 pandemic.

The Health Sciences and Technology Academy (HSTA): Providing 26 Years of Academic and Social Support to Appalachian Youth in West Virginia.

The Health Sciences and Technology Academy's, (HSTA) goals are to increase college attendance of African American, financially disadvantaged, first generation college and rural Appalachian youth and increase health-care providers and STEM professionals in underserved communities. Students enter in the 9th grade and remain in HSTA four years. They engage in a rigorous academic program within the nurturing environment of small after-school clubs punctuated by yearly summer camps on multiple college campuses. A distinctive piece of HSTA is its students' development of research projects under the mentorship of teachers and researchers that examine and address health issues faced by their communities. The projects help HSTA students to understand the health dynamics in their local community, transforming them into community advocates who address health and social issues at home as they prepare to move on to college and beyond. Substantial in-state tuition waivers inspire 99% of the 3,021 HSTA graduates to attend college versus 56% of WV high school graduates. Approximately 85% of matriculating HSTA students graduate with a four-year degree or higher versus less than 50% of all college entrants. To date, 57% of HSTA students go into health and other STEM majors, much higher than the state and national figures.

Providing Oral Health Education to Adolescents with Peer-Assisted Learning.

There is a need to increase oral health knowledge, attitudes and behaviors in children to improve oral health. This research involves peer-assisted learning to determine if high school students can influence rural middle school students' oral health. The study sample consisted of middle school students. After completing pre-test, they were assigned to receive 1) didactic peer-assisted learning with professionally supervised and educated high school students (members of an after-school pipeline program for science, technology, engineering, mathematics, and health science); or, 2) teacher provided handouts/activity sheets. Both groups then completed a post test. The results of the Mann-Whitney U Tests showed that brushing and flossing failed to reach significant improvements between the pre-test and post-test for the handouts/activity sheets group (brushing, P=0.391; flossing, P=0.459). There was improvement within that group for oral health knowledge (P<.001). Brushing, flossing and oral health knowledge failed to reach significant improvement between the pre-test and post-test for the peer-assisted learning group (brushing, P=0.760; flossing, P=0.707; oral health knowledge, P= 0.154). In terms of oral health knowledge, there was no difference between the scores of the two groups on the pre-test (P-value = 0.980) nor on the post-test (P-value= 0.237). Near-peer assisted learning for oral hygiene knowledge, attitudes, and behaviors had similar outcomes as teacher provided handouts and activity sheets in a middle school setting.

Social Media Based STEM Enrichment Curriculum Positively Impacts Rural Adolescent Health Measures.

Some STEM outreach programs connect students to real-world problems and challenge them to work towards solutions. Research shows one-third of children between ages 5-17 in the U.S. are overweight. Socioeconomic status, race, and parental educational attainment all influence this issue as well as living in a rural or urban area. A rural high school STEM outreach program used a social media curriculum focused on healthy lifestyles and measured impact on the health of adolescents from these backgrounds. Health screenings and college mentors were provided to 134 adolescents from 26 counties in WV. The social media intervention lasted seven months with participants using near-peer and mentor support to achieve personal health goals set at the initial health screening. The results of pre- and post-intervention health screenings were compared for any changes in health measures by student goal and participation. BMI decreased significantly in the group of participants who selected a weight loss goal, while those choosing to improve their nutrition significantly increased healthy cholesterol levels. A positive impact was seen on adolescent health outcomes through linking a high school STEM outreach program with a higher education institution to deliver STEM enrichment curriculum through social media.

Taking a Look at the Heath Sciences and Technology Academy (HSTA): Student-Research Partnership Increases Survey Size, Hands-on STEM Learning, and Research-Community Connections.

This paper explores the dynamics of a research partnership between a practicing clinician/research and 34 West Virginia high school students participating in a precollege STEM intervention program. The collaboration provided a more diverse study sample to the clinician for examining attitudes about knee osteoarthritis in adults over 40. It provided students the opportunity to collect data from adults in their community within a highly structured research project and explore a range of research questions using the resulting cross-state data set. Data collection far surpassed the researcher's expectations of 100 surveys; student researchers collected 1,129 unique surveys over nine months from difficult to reach Appalachian communities. This project illustrates the intervention program's ability to support partner research efforts while opening the STEM pipeline to under-served youth by introducing aspects of community-based participatory research (CBPR) pathways to them in their formative years.