CORE Posters Fall 2025

Promotion of Whole Person Care: Expanding the Scope of Primary Care to Include Basic Oral Health Madeleine Sifford, Delaney Connolly, Anneli Kramer, Siddhant Pathak, Zachary Morris, Aashima Sagar, Leena Seyam, Jessica Nicholson, Bernard Kadio MD, MPH, PhD

Group A

Edward Via College of Osteopathic Medicine – Virginia Campus, Department of Preventative Medicine, Blacksburg, VA Abstract Results Discussion

Rural Virginia faces a significant shortage of oral healthcare providers, leaving residents with unmet oral health needs that can contribute to greater systemic health complications. This study aims to assess local physicians' oral health knowledge, perceptions of barriers to care, and willingness to incorporate basic oral health screenings in practice. A survey was distributed to physicians at Lewis Gale Montgomery Hospital, yielding 28 responses. The results indicate that given the proper training, 82.14% of the surveyed providers would be willing to implement basic oral health screenings into their practice. These findings encourage further research and highlight an opportunity to expand oral healthcare access through physician collaboration. Oral health is closely linked to systemic health outcomes, including infection, cardiovascular disease, and cancer¹. The New River Valley (NRV) continues to face significant barriers in oral healhcare². In Montgomery County, there is only one dentist per 1,940 residents , and other NRV counties report even greater shortages³. Aims: • Assessing physician knowledge about oral health • Surveying provider willingness to integrate oral health assessments • Identifying barriers to oral health screening integration Introduction

• The collected data indicates that most surveyed physicians support the integration of oral health screenings into clinical practice

Characteristic Overall (n=28)

Degree

0

MD DO

42.86%(12) 57.14%(16)

2

1

• Respondents identified various systemic and educational barriers that impede oral health screening implementation

Specialty

Internal Medicine Family Medicine Other

53.57%(15) 35.71%(10) 10.71%(3)

11

• Improving physician education can encourage early treatment initiation and mitigate downstream systemic health consequences • These results underscore the need for multilevel policy development to address physician-identified barriers and improve patient health outcomes

Experience

14

1-3 years 3-6 years 6-12 years >12 years

89.29%(25) 3.57%(1) 0.00%(0) 16.67%(2) 82.14%(23) 35.71%(10) 39.29%(11) 3.57%(1) 64.29%(18) 64.29%(18) 7.14%(2)

Not important

Less important

Patient population

Rural Suburban Uninsured/Underinsured Non-English speaking Low SES Middle SES High SES

Not sure

Important

Limitations: Sample size, locality, and respondent experience

Very important

Figure 1: Opinions on the Importance of Oral Health for Overall Patient Wellbeing

Conclusion and Future Work

Our findings suggest that physician intervention can serve as an avenue to address oral health disparities in underserved areas, through the integration of basic screenings into routine care.

Table 1: Study participant demographics; SES: Socioeconomic status

5

Expand scope of research

Develop interventions

Advocacy

References

1. World Health Organization. Oral Health. 2. Carilion Clinic. 2021 CNRV Community Health Assessment Report. 3. County Health Rankings & Roadmaps. Floyd County, Virginia. 2024. 4. Vernon LT, Teng KA, Kaelber DC, Heintschel GP, Nelson S. Time to integrate oral health screening into medicine? A survey of primary care providers of older adults and an evidence-based rationale for integration. Gerodontology. 2022 Sep;39(3):231-240. doi: 10.1111/ger.12561. Epub 2021 May 28.

We predict that physicians will be amenable to integrating oral health screenings into their practice.

0

20

40

60

80

100

Methods

Percentage of Survey Respondents

Perceived Scope of Practice Lack of Educational Materials Inadequate Training Time

A survey 4 was modified and administered to assess variables related to the physicians' knowledge and opinions regarding oral health. • Study Design: Cross-sectional survey study • Sample: 28 physicians practicing at Lewis Gale Montgomery Hospital on September 12, 2025 o Exclusion Criteria: Physicians practicing solely in private offices • Tools: Electronic survey – QuestionPro Descriptive analysis – Microsoft Excel

Figure 2: Perceived barriers to implementation of oral health screening

Acknowledgements

• 96.43% of respondents believe practitioners should "frequently" or "occasionally" inquire about or assess patients' oral health status • 82.14% of respondents would be open to integrating oral health screening into their practice if provided adequate training and education

We would like to express our gratitude to Rhonda Seltz and the Virginia Poverty Law Center for their support on this project. Edward Via College of Osteopathic Medicine Institutional Review Board, [2315396-1] Promotion of Whole Person Care: Expanding the Scope of Primary Care to Include Basic Oral Health,Approved August 7, 2025.

Development of an AI-based App. for Reducing Barriers to Care and Community Health Services in Rural and Remote Areas. Abban-Faidoo, E, Dalton, S, Kuchan, G, Lee, S, Lovill, K, Makarov, A, Shorey, P, Werth, J., Nicholson, J., Kadio, B. Department of Preventive Medicine

Group B

Results

Results

Introduction

Rural areas like Floyd County, Virginia, face persistent barriers to healthcare access. Despite efforts by the Tri Area Community Health Clinic and others like it, gaps remain in reaching patients. Our project conducted a needs assessment to develop a patient-centered AI tool to address barriers and connect individuals to Federally Qualified Health Center services (FQHS) and community resources.

Conclusions

Next Steps: Based on the feedback from the pilot study, the survey will be further distributed, and the subsequent phases will focus on developing and distributing a patient-centered AI tool for Tri-Area Community Health. The survey will be distributed in person at the Tri-Area Community Health clinic over approximately a month. The data gathered from these surveys will help direct the creation of the AI application.

Our goal is to improve healthcare accessibility and outcomes for underserved rural populations.

What could this AI application look like? Below is a working mockup of the proposed product.

Methods

The purpose of this initial survey phase was not to generate final conclusions, but rather to gauge where respondents currently stand and how they feel about the potential role of AI in their personal healthcare. Early responses suggest a range of attitudes, from cautious curiosity to notable interest.

Research Question: For the residents of Floyd, how might the implementation of a user-based AI model enhance access to FQHC services and community resources in comparison to traditional methods?

References

Participants: Recipients of services from the Tri-Area Community Health Clinic in Floyd, VA.

References

Needs Assessment Survey: A pilot needs assessment survey was conducted to evaluate current factors limiting patient access to care and community resources.The survey was designed using the Pechansky Model of Access to Care, which focuses on five dimensions: availability, accessibility, accommodation, affordability, and acceptability.

Acknowledgements

We thank Dr. Bernard Kadio and Jess Nicholson for their guidance, and Tri-Area Healthcare, with special appreciation to Dr. Jim Werth and Mariam DiPasquale for their contributions. This project remains under IRB review.

Promotion of Whole Person Care: Development and Integration of a Behavioral Care Service at a Federally Qualified Health Center Gerges J, Kalu R, Keene H, Mackintire K, Osuorah O, Patel J, Serra B, Worth J, Nicholson J, & Kadio B Department of Preventive Care, Epidemiology and Public Health, Edward Via College of Osteopathic Medicine, Virginia Campus

Group C

Introduction

Results

Conclusions

• Often people in the county of Floyd are not confident or only somewhat confident that they would be able to have access to behavioral health services when needed • Many of the participants have experienced some sort of mental health difficulties in the last 12 months: stress, depression, insomnia, abuse, substance use, or family/relationship difficulties • Approximately half of participants have previously been diagnosed with a mental health illness • Many of respondents have previously attended therapy, counseling, or have accessed mental/behavioral health services in the past • Residents of Floyd county identify the main barriers to behavioral health care as limited availability of services, high costs, and lack of insurance. • All respondents found it was either very important or somewhat important for behavioral health services to be more available and all, but one respondent, would use these services • The most desired behavioral health services are individual therapy, group therapy, support groups, medication management, and stress management. • Provides baseline pilot data on behavioral health needs in a rural community, highlights the prevalence of mental health challenges, and identifies barriers and service preferences that can inform program development • Next steps: Implementation of services and determine the extent that these services are being used at the Peer Center in Floyd or desire for more/different services than what are currently being offere d

• Behavioral health issues, particularly substance use disorders (SUDs), are a growing concern in the New River Valley, practically in Floyd County. • According to the 2024 community health needs assessment, overdose deaths have risen by 105% over the past five years among the New River Valley residents 1 . • The New River Valley has fewer mental health providers (68 per 100,000 residents) compared to the state average (84 per 100,000), emphasizing a need for better access to services 1 . • Peer centers are community-based treatment centers for people suffering from substance abuse disorders or mental illness 2 . They provide an alternative to inpatient care and are normally free to attend. • The goal of this project is to identify the behavioral health services most desired by residents of Floyd County to enhance engagement with and utilization of a new peer health center.

Figure 1. Reported confidence in respondents' ability to access behavioral health services in Floyd County

Methods

Variables: Predictors: age, gender, housing status, behavioral health/substance use history Outcomes: service needs, preferences, willingness to engage, barriers

Design: Cross sectional, community based, mixed methods study (April – September 2025)

Inclusion Criteria: 18 years or older Exclusion Criteria: Non-Floyd County Residents Population: Residents of Floyd County, Virginia

References

Figure 2. Reported barriers to receiving behavioral health services in Floyd County

1. United Way of Southwest Virginia. New River Valley Community Assessment . Published 2024. Accessed September 19, 2025. 2. Kowalski MA. Mental health recovery: The effectiveness of peer services in the community. Community Ment Health J . 2019;56(3):568-580. doi:10.1007/s10597-019-00514-5 3. Health Resources & Services Administration. Guidance for Federally Qualified Health Center (FQHC) Needs Assessments . Accessed September 19, 2025. 4. Substance Abuse and Mental Health Services Administration. Community Behavioral Health Survey Examples . Accessed September 19, 2025. 5. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS) Mental Health and Access-to-Care Items . Accessed September 19, 2025.

Analysis: Descriptive statistics, χ² and t tests for associations; thematic analysis of open-ended responses

Data Collection: Anonymous paper/digital surveys administered with demographics, Likert scale items on service attitudes, and open ended questions

Acknowledgements

Thank you to our community partner, Tri-Area Community Health, for their continued support and communication and to the 401 Peer Center in Radford for allowing us to determine what

services are most used at their peer center. Edward Via College of Osteopathic Medicine Institutional Review Board # 2025-074 Approval on September 16, 2025

Figure 3. Behavioral health services most needed in Floyd County according to respondents

Musculoskeletal Health and Social Participation: An Osteopathic Perspective on Healthy Aging; A Two-Phase Qualitative-Quantitative Analysis Donald L. 1 , Emdad T. 1 , Hass N. 1 , Kumar E . 1 , Martinez J. 1 , Martinez N. 1 , Welch J. 1 , Williams L. 1 , Harrah K . 2 ,Nicholson J. 3 , Kadio B. 3 1. Edward Via College of Osteopathic Medicine 2. Warm Hearth Village 3. Department of Preventive Medicine, Edward Via College of Osteopathic Medicine

Team D

Abstract

Results

Conclusions

• Physical activity plays a crucial role in promoting healthy aging as it serves to mitigate age-related diseases and improves overall well being. • This study aims to examine musculoskeletal health and social participation while assessing the impact of exercise classes on balance, social connections, and overall quality of life among Warm Hearth participants. • A two-phase study: Phase I was conducted following the Level 1 and Level 2 Posture, Balance, and Gait classes, which averaged approximately 15 and 23 – 27 participants, respectively. Phase II will comprise of data collection via surveys, offered to the participants to further understand their own perception of how community based physical activity benefits their health, mobility, and emotional well being. Phase I results demonstrated improvements in both balance and perceived quality of life. • In conclusion, this study discuses and contributes to the conversation of healthy aging by highlighting the significance of physical activity and community engagement as critical tools for promoting well-being in older adults. Phase I: Observational Study • Investigators attended Level 1 and Level 2 Posture, Balance, and Gait exercise classes at Warm Hearth Village to observe exercises and activities performed. • Participants were observed completing balance exercises while engaging in a community-based setting. Phase II: Quantitative Analysis • Approximately 16-18 participants aged 65 and older will be recruited from the level 1 posture, balance, and gait classes at Warm Hearth Village. • Each participant's balance will be measured using the Berg Balance Scale. • Participants will complete two surveys, the Activities-specific Balance Confidence (ABC) Scale to measure perceived balance confidence and the Older Person’s Quality of Life Questionnaire (OPQOL -35) to assess perceived quality of life. • Participants will attend a Warm Hearth Level 1 Posture, Balance, and Gait exercise class once a week for six weeks. • After the six week of classes, Participants balance with be reassessed and they will retake both surveys to measure any perceived changes in balance confidence and life satisfaction over the course of the research period. Introduction or Methods

Demographics Warm Hearth is a rural based organization in Blacksburg Virginia, serving the elderly of diverse socioeconomic demographics. Classes are offered to adults aged 65 years and older seeking to improve their gait and balance.

Phase I: Observational Study • Observation of the class revealed that it contributed to healthy aging by blending physical activity, social engagement, and emotional well being • Residents demonstrated improvements in balance to be independent in their homes for longer. • The class also afforded them the opportunity to engage in meaningful social connections. • The uplifting environment saw aging as something to celebrate by supporting residents' mental, physical, and emotional well-being • This phase of the study reinforced the value of movement and social engagement at every age, especially in older individuals. Phase II: Quantitative Analysis • Measure quality of life with the OPQOL, confidence in balance with the ABC Scale, and balance performance with the Berg Balance Scale. • This will provide more evidence on how effective group fitness classes are for older adults. • It will show quantitatively that group classes can improve both physical health and quality of life.

Why these classes are important:

• Falls are the leading cause of injury and injury-related death in adults ≥65, affecting ~1 in 4 each year. 4 • Consequences are severe: hip fractures, traumatic brain injury, loss of independence, and a doubled risk of premature death. 1 • Economic burden is enormous, exceeding $50 billion annually in U.S. healthcare costs. 2 • Balance and strength training programs reduce fall risk by up to 40%, making prevention highly effective and evidence-based. 3

Figure 1. Distribution of injury-related deaths in the United States, 2012 – 2013 5

Observations "Volunteering for the posture and balance class was a positive experience...Several residents mentioned improvements in their balance since starting the course and how they enjoyed the company...." "The physical activity (of the Warm Hearth exercise classes) greatly benefits the residents, helping them to stay fit and exert themselves to not lose functionality in activities of daily living, such as balance and stamina." Participation in the six-week posture and balance program is expected to yield measurable improvements in physical function and psychosocial health among older adults. Preliminary Phase I findings demonstrated visible improvements in balance and engagement throughout the Posture, Balance, and Gait classes. Based on these findings, Phase II is expected to yield measurable gains across both objective and subjective outcomes: • Balance Performance: Post-intervention Berg Balance Scale scores are expected to show statistically significant improvements, indicating enhanced postural stability and reduced fall risk. • Balance Confidence: Gains are anticipated on the Activities-specific Balance Confidence (ABC) Scale, reflecting increased confidence in mobility. • Quality of Life: Participants are expected to report higher Older Person's Quality of Life Questionnaire (OPQOL-35) scores, with the greatest improvements in physical health, social participation, and psychological well-being.

References

1. Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693-698. doi:10.1111/jgs.15304 2. Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults — United States. J Safety Res. 2016;58:99-103. doi:10.1016/j.jsr.2016.05.001 3. Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019;1(1):CD012424. doi:10.1002/14651858.CD012424.pub2 4. Centers for Disease Control and Prevention (CDC). Important Facts about Falls. Updated 2024. Accessed September 14, 2025. https://www.cdc.gov/falls/facts.html 5. Chittrakul, J., Siviroj, P., Sungkarat, S., & Sapbamrer, R. (2020). Multi-System Physical Exercise Intervention for Fall Prevention and Quality of Life in Pre-Frail Older Adults: A Randomized Controlled Trial. International journal of environmental research and public health , 17 (9), 3102. https://doi.org/10.3390/ijerph17093102

Acknowledgements

We would like to thank the VCOM IRB for their work with us throughout this process. We would like to thank Mr. Kenny Harrah and the Warm Hearth Retirement Community for their advice and participation. We would like to thank Ms. Jessica Nicholson and Dr. Bernard Kadio for their work with us and this presentation.

Group E

Social Capital Development and Fall Prevention: A DO Students Community-based Intervention to Promote Healthy Aging Using Friendship Cafes and Bingocize ® Grimaldo M.T., Axline V.J., Khan N., Ni J., Orosz A., Wood C., Yacoub M., Nicholson J., Kadio B. Edward Via College of Osteopathic Medicine, Preventative Medicine, Blacksburg, VA

research design, study implementation, and data analysis and interpretation.

Conclusion

Abstract

Results

• Fewer participants felt pain negatively affected their well-being post Bingocize ® compared to pre-Bingocize ® , suggesting that Bingocize ® may have reduced perceived pain's impact on overall well-being. • Since Bingocize ® , 50% of participants agreed or strongly agreed that they had fallen less and were less fearful of falling, while 50% of participants neither agreed nor disagreed, indicating a potential physical benefit to the Bingocize ® program. • A total of 83.3% of participants agreed they wanted more compassion or contact with others, and 66.6% of participants agreed they'd like more people to enjoy life with.

The growing incidence of falls combined with lack of social support poses a serious risk to the health and well-being of elderly populations. 2 New River Valley’s Agency on Aging, an organization improving the lives of older adults, combats this by implementing Bingocize ® Fall Prevention programs within their Friendship Cafés. 4 In partnership with Agency on Aging, this research seeks to evaluate the benefits of the Bingocize ® program and provide a deeper understanding of how the Bingocize ® program enhances elderly social and physical well-being in Pulaski County. Using the adapted OPQOL-35 survey, this research will help provide evidence for further funding of valuable programs for the elderly in rural communities. 1

Table 1. Participant Demographics. This study evaluated six former participants of the Bingocize ® Fall Prevention Program at the Pulaski Friendship Café.

Figure 2. Comparison of participants' response to "Pain affected my well-being" before and after Bingocize ® . After participating in Bingocize ® , participants' perceptions of how pain affects their well-being shifted significantly, with fewer people strongly agreeing that pain impacts them.

Limitations, Outcomes, Future Directions

Introduction

• The sample size is small (n=6), limiting generalizability. • The outcomes trend towards a decreased fall risk, reduced perception of pain, and an increase in physical energy. • The findings suggest a future direction of exploring health related to social interaction and companionship in elderly populations within this community. • There is a significant need for community-based activities like Bingocize ® from a physical and psychosocial perspective.

• Pulaski is a small rural community in Southwest Virginia with a total population of 33,800 persons, of which 22.6% are greater than 65 years old 5 • Friendship Cafés are a service provided by New River Valley’s Agency on Aging and play a central role in enhancing social interactions and lifestyles of the elderly community in Pulaski County 4 • Friendship Cafés provide social enrichment for the local elderly population by allowing meaningful interaction while enjoying a hot meal • The Bingocize ® Fall Prevention program combines bingo, exercise, and education, to empower individuals, improve physical health, and increase social engagement. 3 However, the benefits of these workshops are not well understood.

Table 2. Participants' perception about their health prior to the Bingocize ® Fall Prevention Program. Prior to participating in Bingocize ® , a significant portion of participants reported a mix of perceptions about their health, with 50% being neutral on whether pain affected their well-being, and a combined 66.67% either agreeing or strongly agreeing that they had enough physical energy and were healthy enough to get out and about.

References

References

Methods

1. Bowling, A. (2009). Older People's Quality of Life Questionnaire (OPQOL-35) [Full Questionnaire] . St. George's, University of London & Kington University. 2. Centers for Disease Control and Prevention. (2024, October 28). Older adult falls data https://www.cdc.gov/falls/data-research/index.html cd 3. National Council on Aging. (2025, January 21). Evidence-Based Program: Bingocize®.https://www.ncoa.org/article/evidence-based-program-bingocize/ 4. New River Valley Agency on Aging. (n.d.). New River Valley Agency on Aging. https://www.nrvaoa.org/index.html 5. U.S. Census Bureau. (n.d.). Pulaski County, Virginia – Profile. https://data.census.gov/profile/Pulaski_County,_Virginia?g=050XX00US5115 5

Table 3. Participant's perception about their health two years after conclusion of the Bingocize® Fall Prevention Program. After concluding Bingocize ® , participants showed significant improvements in their health perceptions, with a majority (83.33%) adopting a neutral stance on pain's effect on their well-being, while 50% strongly agreed they had more physical energy, and 66.67% agreed they were healthy enough to get out and about.

Figure 1 . Experimental Design. This cross-sectional experimental study was designed to evaluate the impact of the Bingocize ® Fall Prevention programs on enhancing social connections and promoting healthy aging among older adults. Individuals aged 60 and older, who previously participated in the Bingocize ® program, completed a survey at the Pulaski Friendship Cafe.

Acknowledgements

Acknowledgements

We gratefully acknowledge the New River Valley Agency on Aging for their support and assistance with this project. This study was reviewed and approved by the Edward Via College of Osteopathic Medicine Institutional Review Board, Blacksburg, VA [IRB Protocol #2315435-2]. Social Capital Development and Fall Prevention: A DO Students Community-based Intervention. Approval Date 9/10/25

Table 4. Evaluation of participant's desire for more social connection following conclusion of the Bingocize ® Fall Prevention Program. Based on the table provided, the data describes participants' social perceptions after the Bingocize program. The findings indicate a strong desire for more social engagement.

IMPORTANCE OF SCREENING FOR CHRONIC KIDNEY DISEASE AMONG THE RETIREES OF WARM HEARTH VILLAGE P. Buchanan, M. DeGrassi, D. Downing, T. Fuchs, A. Funkhouser, E. Geddes, W. Iftikhar, Y. Moustafa, J. Nicholson, MAT, and B. Kadio, MD, MPH, PhD Edward Via College of Osteopathic Medicine, Blacksburg – VA Group F

Abstract

Results

Conclusions

• Understanding of kidney health: 81.8% reported an increased understanding (54.5% very much) • Clarity of explanation: 45.5% completely clear, 45.5% somewhat clear, 9% not clear • Convenience (time, location, cost): 36.4% very convenient, 36.4% convenient, 27.3% neutral • Satisfaction: 63.7% were satisfied or very satisfied with the program • Future: 100% support expansion

Chronic kidney disease often shows no symptoms until the later stages, and older adults are at higher risk. The purpose of this study is to evaluate whether the October 2024 Warm Hearth Village CKD screening improved awareness, knowledge, and follow-up care. This was a cross-sectional, anonymous survey of residents who participated in the screening. Survey of 11/36 participants showed: program was convenient or very convenient (72.8%), program improved understanding of kidney health (81.8%), explanations varied in clarity (45.5% completely clear, 45.5% somewhat clear, 9% not clear), program left them satisfied or very satisfied (63.7%), and strong interest in future screenings (81.8%). Every responder agreed with expansion to other communities (100%). Improvements: explanation of results, time/availability, wait time, follow up communication. Community screenings are feasible, but enhanced scheduling, staffing, education, result explanation are needed. Chronic kidney disease affects approximately 37 million adults in the United States, with the highest prevalence in older populations. Among adults aged 65 and older, 38 percent show signs of CKD, yet fewer than 10 percent are aware of their condition. Warm Hearth Village represents an ideal population to evaluate the effectiveness of screening. There is limited evidence regarding whether community screenings improve follow-up care and education quality. This study aims to assess awareness, knowledge, usefulness, and follow-up among older adults following a CKD screening. This study was designed as an observational, survey-based project. The population included residents of Warm Hearth Village who attended the October 2024 CKD screening. A de-identified paper and online survey was distributed and collected by Warm Hearth staff. Residents completed the survey independently online or on paper to return it to a designated drop-off location. Measures included perceived usefulness of education, CKD knowledge, lifestyle changes, follow-up care, satisfaction, and medication adherence. Introduction Methods

References References While our research focused solely on retirees of the Warm Hearth Village, we acknowledge that the results could be limited as not everyone who participated in the kidney screening responded to the survey. This could be due to lack of access to email, cognitive disabilities, or loss to follow up given the original screening was in 2024. Most importantly, all Warm Hearth Village participants who responded to the survey (100%) stated that the screening should be expanded to other communities. To address concerns that many participants felt their results were not adequately explained, we suggest the following recommendations: • Provide results in each participant’s preferred format (written, email, etc.). • Offer onsite appointment scheduling. • Include clear follow-up steps. • Provide educational materials with simple language and visuals to support understanding of diet, exercise, and medication management. Collectively, these strategies can improve participants’ understanding of their health, strengthen appreciation for the program, and increase follow-up completion rates. 1. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. U.S. Department of Health and Human Services, CDC. https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html 2. Centers for Disease Control and Prevention. (2024). Chronic kidney disease in the United States, 2024. U.S. Department of Health and Human Services.https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html 3. Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012;379(9811):165 – 180.https://doi.org/10.1016/S0140 6736(11)60178- 5​ 4. Najm, S. H., & Sameen, E. K. (2025). Assessment of health awareness concerning hypertension among visitors to primary health care centers. Central Asian Journal of Medical and Natural Sciences. 5. National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Kidney disease statistics for the United States. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/health-statistics/kidney disease​ 6. Scott, S., Grewal, E. K., Varma, M., et al. (2025). Evaluation of a pilot outreach program to support point-of-care screening for individuals with diabetes who are experiencing homelessness in Alberta, Canada. BMC Health Services Research. 7. Stevens PE, Levin A; Kidney Disease: Improving Global Outcomes (KDIGO) CKD Guideline Development Work Group. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825 – 830.https://doi.org/10.7326/0003-4819-158-11-201306040 00007

Did you receive clear explanations about your screening results?

9.1%

45.5%

45.5%

Screening Program Satisfaction

27.3%

36.4%

36.4%

Did the screening program help you understand your kidney health better?

9.1%

9.1%

27.3%

Acknowledgements

54.4%

We thank the residents and staff of Warm Hearth Village, the Kidney Screening and Awareness Program at Virginia Tech, and Edward Via College of Osteopathic Medicine – Virginia. We acknowledge Dr. Bernard Kadio (PI), Katherine, Sarah McCarter (Volunteer and Academic Partnerships Coordinator for Warm Hearth), and the Department of Preventive Medicine.

This study was approved by the Edward Via College of Osteopathic Medicine Institutional Review Board, Protocol #2315423-1.

Group G

Cancer Long-Term Assessment Intervention Relief and Education (C.L.A.I.R.E.) Hisham Zahid, MS, Mahad Alam, BS, Yen Ha, BS, Ayeshah Qureshi, MS, Mallory Duggan, BS, Elijah Akinade, MPH, Jessica Nicholson, MAT, Bernard Kadio, MD, PhD, MPH Edward Via College of Osteopathic Medicine, Preventative Medicine, Blacksburg, VA

Abstract

Results

Discussion

Lung cancer remains a leading cause of cancer-related death, with rural and underserved populations facing higher risk due to tobacco use, occupational exposures, and environmental factors. To improve screening, we developed the Cancer Long-term Assessment Intervention Relief and Education (C.L.A.I.R.E.) Lung Cancer Risk Screening Tool, an evidence-based model designed for community health centers. Risk factors identified through a targeted literature review included age, smoking history, COPD severity, radon, asbestos, air pollution, family history, and secondhand smoke. Weighted scores (0 – 26) were assigned based on relative contribution and synergistic effects, with patients stratified into low (0 – 6), moderate (7 –13), and high (≥14) risk categories. An initial feasibility assessment studied clarity, applicability, and integration into clinical practice. By combining traditional and environmental risk factors, the C.L.A.I.R.E. tool offers a practical, multivariable approach to guide low-dose CT screening and reduce disparities in lung cancer prevention. Future studies will refine thresholds and validate its predictive accuracy. Community health centers play a vital role in addressing health needs, especially for those who are uninsured or underinsured. Many of these centers, clinics, and mobile units are run by smaller organizations, and volunteer efforts are crucial to meet the needs of these communities. According to the 2024 New River Community Health Assessment (NRCHA), malignant neoplasms rank as the second leading cause of death. The assessment particularly highlights a high prevalence of lung disease in the area, with tobacco use identified as a significant contributing factor to the development of these diseases. At the Community Health Center of the New River Valley (CHCNRV), there are currently over 400 patients documented as active smokers who have not received a lung cancer risk assessment or undergone informed decision making to determine the necessity of screening. This study aims to identify risk factors and develop a screening tool for identifying those who qualify for low-dose computed tomography (LDCT). The findings from this research will help decrease the prevalence and mortality of lung cancer, especially in at-risk populations of rural communities like Montgomery County. Evidence Review and Risk Factor Selection A targeted literature review of recent meta-analyses, clinical guidelines, and validated prediction models was conducted to identify the most significant contributors to lung cancer risk. The final set of factors included age, smoking history, COPD severity, residential radon exposure, occupational asbestos exposure, outdoor air pollution, family history of lung cancer, and secondhand smoke exposure. Weight Assignment and Scoring Framework Each risk factor was assigned a weighted point value proportional to its relative impact on lung cancer development. The framework emphasized dose – response relationships and recognized synergistic effects. Smoking history carried the highest weight, while interaction bonuses were applied when multiple exposures were present (e.g., smoking combined with asbestos or elevated radon exposure). Risk Stratification and Tool Design The resulting Cancer Long-term Assessment Intervention Relief and Education (C.L.A.I.R.E.) Lung Cancer Risk Screening Tool calculates a cumulative score on a Moderate Risk (7 – 13 points): Shared decision-making regarding LDCT screening. High Risk (≥14 points): Strong recommendation for LDCT screening, with expedited referral if interaction bonuses are present. This structured approach ensures that lung cancer risk is evaluated holistically, while remaining practical for use in rural and resource-limited health settings. Introduction Methods 0 – 26 point scale. Patients are stratified into three categories: Low Risk (0 – 6 points): Routine care and preventive counseling.

The C.L.A.I.R.E. tool was developed to address lung cancer screening gaps in rural and underserved populations. It integrates both traditional factors, like age and smoking, and additional risks such as COPD, radon, asbestos, air pollution, family history, and secondhand smoke. By assigning weighted scores, it captures dose – response effects and combined exposures, stratifying patients into low risk (counseling and prevention), moderate risk (shared decision-making for LDCT), and high risk (strong LDCT recommendation). Pilot testing will assess feasibility, clarity, and smooth integration into community clinic workflows.

Conclusions

The C.L.A.I.R.E. scoring criteria offer a comprehensive and evidence-based method for lung cancer risk stratification by integrating age, smoking history, COPD severity, environmental exposures, air pollution, family history, and secondhand smoke. By categorizing patients into low, moderate, or high risk, the tool aligns clinical recommendations with appropriate low-dose CT screening strategies. As a multivariable model, C.L.A.I.R.E. supports informed, patient-centered decision making in lung cancer prevention and early detection. Future implementation studies across diverse and underserved populations will be essential to validate its sensitivity and specificity, refine thresholds, and strengthen its role as a standardized screening tool in community health settings.

• OR = Odds Ratio (relative risk compared to baseline). • 95% CI = 95% Confidence Interval. • Pack -years = (packs smoked per day) × (years smoked). • yr = years. • Bq/m³ = Becquerels per cubic meter (radon concentration unit).

• GOLD = Global Initiative for Chronic Obstructive Lung Disease staging for COPD. • LDCT = Low -Dose Computed Tomography (lung cancer screening modality).

Acknowledgements

We would like to thank the Community Health Center of the New River Valley for their support and commitment to improving rural health outcomes. Special thanks to our faculty mentors and colleagues at the Edward Via College of Osteopathic Medicine (VCOM – Virginia) for their guidance throughout this project. Finally, we are grateful to the patients and community members whose needs inspired the development of the C.L.A.I.R.E. Lung Cancer Risk Screening Tool.

References

Byun J, et al. Genome-wide association study of familial lung cancer: Evidence for genetic susceptibility. Carcinogenesis . 2018;39(9):1135-1144. doi:10.1093/carcin/bgy080 Elkefi S, et al. Secondhand smoke exposure and lung cancer risk: A population-based analysis. Int J Environ Res Public Health . 2025;22(4):595. doi:10.3390/ijerph22040595 Kim SH, et al. Family history of lung cancer and lung cancer risk: A systematic review. Cancers (Basel) . 2024;16(11):2063. doi:10.3390/cancers16112063 Klebe S, et al. Asbestos, smoking, and lung cancer: An update. Int J Environ Res Public Health . 2019;16(1):258. doi:10.3390/ijerph17010258 Krist AH, Davidson KW, Mangione CM, et al. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA . 2021;325(10):962-970. doi:10.1001/jama.2021.1117 Mphaga KV, et al. Indoor radon exposure and lung cancer risk: Systematic review and meta-analysis. Environ Res . 2024;241:117257. doi:10.3389/fpubh.2024.1328955 Ngamwong Y, et al. Additive synergism between asbestos and smoking in lung cancer risk: A systematic review and meta-analysis. PLoS One . 2015;10(8):e0135798. doi:10.1371/journal.pone.0135798 Possenti I, et al. Secondhand smoke exposure and lung cancer: A meta-analysis. Eur J Cancer Prev . 2024;33(6):493-503. doi:10.1183/16000617.0077-2024 Ramamoorthy T, et al. Ambient air pollution and global cancer burden: A comprehensive meta-analysis. JCO Glob Oncol . 2024;10:e2300427. doi:10.1200/GO.23.00427 Rodríguez-Martínez Á, Ruano-Ravina A, Torres-Durán M, et al. Residential radon and lung cancer risk: Dose – response effect in small cell lung cancer. Arch Bronconeumol . 2022;58(1):27-34. doi:10.1016/j.arbres.2021.01.027 Tammemägi MC, et al. Selection criteria for lung-cancer screening. Lancet Oncol . 2022;23(8):1097-1107. doi:10.1016/S1470-2045(21)00590-8 Turner MC, et al. Long-term ambient air pollution exposure and lung cancer incidence: A cohort study. Environ Health Perspect . 2011;119(7):862-868. doi:10.1164/rccm.201106-1011OC Urrutia-Pereira M, et al. Residential radon exposure as a risk factor for lung cancer in Latin America. J Bras Pneumol . 2023;49(6):e20230085. doi:10.36416/1806-3756/e20230210 Zhao G, et al. Prevalence of lung cancer in patients with COPD: A systematic review and meta-analysis. Front Oncol . 2022;12:947981. doi:10.3389/fonc.2022.947981

Risk Stratification: • Low Risk (0–6 points): Routine care; prevention and monitoring.• Moderate Risk (7 – 13 points): Shared decision-making for LDCT; consider mitigation. • High Risk (≥ 14 points): Recommend LDCT promptly; expedite if interaction bonuses apply.

Barriers and Facilitators to the Utilization of Community-Based Preventive Care Services for Children Among Low-Income Mothers in Southwest Virginia: A Cross-Sectional Study

Barnett, E., Blackshear, A., Boesler, J., Boling, J., Brown, M., Jeizan, P., Vuthuri L., Zarzar M., Kelly, S., Nicholson, J. MAT, & Kadio B. MD, PhD. ​ Edward Via College of Osteopathic Medicine, Preventive Medicine, Blacksburg, Virginia.

Group H

Results

Abstract

Conclusion

• The Child’s Health Improvement Partnership (CHIP) delivers essential home visits and supportive services to low-income families. • Giles County, Virginia still experiences elevated rates of child mortality, poverty, and adverse maternal-child outcomes, suggesting underutilization of CHIP services. o This study seeks to identify barriers to CHIP utilization and evaluate strategies to improve enrollment.

Key Findings • Barriers are multifactorial, overlapping, and not explained by single factors. • Emotional barriers (stress, fear, stigma) showed the most variability and may strongly deter service use. • Current sample skews toward white, insured families, likely underrepresenting challenges faced by uninsured and minority groups. Implications • Need for holistic, multi-level interventions. • Tailored outreach for uninsured and diverse populations. Next Steps • Phase 2: Design and pilot evidence-based interventions using literature, Phase 1 findings, and local needs. • Phase 3: Scale successful interventions community-wide and assess impact. References 1. Wild CEK, O’Sullivan NA, Lee AC, et al. Survey of Barriers and Facilitators to Engagement in a Multidisciplinary Healthy Lifestyles Program for Children. Journal of Nutrition Education and Behavior. 2020;52(5):528-534. doi:10.1016/J.JNEB.2019.10.010 2. Medavarapu H. Sycamore Scholars Sycamore Scholars Electronic Theses and Dissertations College Students’ Perceptions of Barriers to Seeking Health Care College Students’ Perceptions of Barriers to Seeking Health Care.; 2014. 3. Pourat N, Lu C, Chen X, et al. Trends in access to care among rural patients served at HRSA-funded health centers. J Rural Health. 2022;38(4):970-979. doi:10.1111/jrh.12626 4. Bureau USC. U.S. Census Bureau QuickFacts: Giles County, Virginia. Published 2025. 5. Bensken WP, Dankovchik J, Fein HL, Duhon G, Sills MR. Unwinding of Continuous Medicaid Coverage Among Pediatric Community Health Center Patients. JAMA Netw Open. 2025;8(2):e2458155. doi:10.1001/jamanetworkopen.2024.58155

• Guided by the Health Belief Model and the Theory of Planned Behavior, we hypothesize that limited awareness,

misconceptions regarding eligibility, and complex enrollment processes represent primary barriers.

Figure 1. Comparison of Average Survey Responses by Respondent's Perceived Barriers by Category. Box and whisker plots displaying the distribution of scores across five categories — Emotional, Structural, Autonomy, Stigma, and Overall Barrier Score. The mean scores are indicated by the X, showing central tendency, while whiskers represent variability and potential outliers in the data. • All barriers played a role in the accessibility of CHIP; however, the impact varied among age, insurance status, and ethnicity • Emotional barriers has the most impact on participants older then 65, are uninsured, and African American • Stigma has the least impact on participants between 55 and 64 years old, are uninsured, and Asian

• Interventions such as enhanced education, community outreach, and enrollment support are anticipated to increase CHIP utilization and improve maternal-child health outcomes in Giles County.

Methods

Data Collection

Recruitment

Survey Distribution

• Recruitment : CHIP-enrolled families (pregnant individuals and individuals with children ages 0-4 meeting Medicaid or income-based criteria). • Surveys : administered to families to assess awareness, accessibility, and barriers to enrollment. • Data collection : focused on utilization patterns and community factors influencing participation.

Thank you to the Children’s Health Improvement Partnership (CHIP) of the New River Community Action for their partnership throughout this project.

Figure 2. Correlation plot of Perceived Barrier Category in relation to their likelihood to seek help

VCOM IRB #2025-057; Approval Date 8/28/2025

Health Literacy and Nutrition Knowledge Attitude and Practice in Mothers Enrolled in the Childhood Health Improvement Program (CHIP) of Southwest Virginia

BucciK 1 ., Gough H 1 ., Jacques TZ. 1 *, Lane N. 1 , Ofori C 1 ., Soares L 1 *., Villegas B. 1 , Shelby K. 2 , Nicholson CJ 3 ., Kadio B 3 .

1. Edward Via College of Osteopathic Medicine, Virginia Campus 2. Children Health Improvement Program, Blacksburg Virginia 3. Department of Preventive Medicine and Public Health Edward Via College of Osteopathic Medicine, Virginia Campus

* Corresponding authors: Soares, Laura: lsoares@vt.vcom.edu; Jacques, Tayce Z. tjacques@vt.vcom.edu

Group I

** This project was undertaken as part of the Community Outreach and Research (CORE) Program at the Edward Via College of Osteopathic Medicine (VCOM), which engages DO students in applied research addressing community health needs.

Abstract

Results

Conclusions

● CHIP participation is linked with improved maternal and childhood nutrition knowledge in southwest Virginia, with the strongest gains in childhood outcomes. ● Self-efficacy scores showed modest improvement over time, though pregnancy literacy remained consistently lower, highlighting a persistent gap. ● These findings suggest that CHIP can extend its impact beyond direct services, but additional targeted strategies are needed to strengthen pregnancy-specific health education and reduce disparities in rural maternal health literacy. ● Addressing structural barriers such as food insecurity, transportation challenges, and healthcare access is also essential to ensuring that the benefits of CHIP are fully acknowledged. Strengthening these areas can help reduce disparities, close knowledge gaps, and improve long-term health outcomes for both mothers and children in rural communities.

In 1964, President Lyndon Johnson’s Economic Opportunity Act created Community Action Agencies (CAAs) to reduce disparities in housing, health, education, and nutrition. The Children’s Health Improvement Program (CHIP) is one such initiative in Virginia, providing in-home maternal and child health services tailored to family needs. Yet despite these programs, gaps in maternal health literacy and nutrition knowledge remain, particularly in rural areas where access to care is limited. Data suggest that rural women are significantly less likely to demonstrate adequate maternal health literacy compared to urban women, underscoring the need for targeted, community-based interventions [1,4]. This study evaluated differences in health literacy and nutrition knowledge among women enrolled in CHIP in Southwest Virginia. Surveys were conducted across Montgomery, Floyd, Giles, Radford, and Pulaski counties to assess maternal nutrition knowledge related to children under six years of age. Mean pregnancy nutrition scores increased from 2.13 (early-term) to 3.13 (long-term), while young child nutrition scores increased from 2.75 to 3.20, demonstrating steady gains with longer enrollment. Self efficacy scores showed a modest positive correlation with knowledge (R² = 0.054 for pregnancy, R² = 0.106 for young child). Findings provide empirical evidence to support targeted interventions, guide CHIP program expansion and policy development, and strengthen outreach strategies to address maternal health education gaps in underserved communities. ● Children’s Health Improvement Partnership (CHIP) is a New River Valley, Southwest Virginia community organization that improves the health of young children and pregnant women to promote self-sufficiency. ● CHIP uses a family-based, in-home care model that pairs families with integrated teams of registered nurses and parent educators. The team helps families keep and maintain appointments, follow physician recommendations, and access medical, dental, and mental health services. ● Urban women are twelve times more likely than rural women to have adequate maternal health literacy [4]. This disparity highlights the urgent need for targeted maternal health literacy programs for low-income households to improve health outcomes [3]. ● Addressing barriers such as access to care, food security, and mental health services ensures that families receive comprehensive support. Introduction We conducted a cross-sectional study in mothers enrolled in CHIP to assess maternal health literacy and nutrition knowledge, attitudes, and practices (KAP) . Study population and Recruitment: 48 mothers currently enrolled in CHIP were surveyed between May-August 2025 during home visits by CHIP representatives and nurses. All responses were anonymous and coded with non-identifying numbers. Exclusion criteria: Non-CHIP participants, declined participation, or surveys with incomplete responses Data Collection: Survey question were adapted from the following validated questionnaires: ● Maternal Health Literacy Inventory in Pregnancy (MHELIP) ● General Knowledge Questionnaire (GNKQ-R) ● USDA Infant and Toddler Feeding Practices Study (ITFP-2) Exposure Variables: Duration in CHIP was assessed via survey and categorized as: Early (0-12 months); Medium-term (13-24 months); Long-term (24+ months) Data Analysis : Descriptive statistics were computed for all variables. To assess the relationships between the exposure variables (self-efficacy/KAP scores) and the outcome variables (nutrition knowledge scores), Pearson’s correlation coefficient was utilized, with statistical significance established at p < 0.05. Linear trendlines were added to scatter plots to illustrate the strength and direction of these relationships, and R² values were reported to indicate the proportion of variance explained. Methods

The study sample comprised 48 women residing in Montgomery, Floyd, Giles, Radford, and Pulaski counties, with ages ranging from 17 to 63 years. Education among participants spanned from a high school diploma to a master’s degree. Duration of involvement with CHIP ranged from 3 to 60 months. Both pregnancy and young child nutrition knowledge increased with longer CHIP enrollment (Figure 1), with pregnancy knowledge showing the strongest linear improvement (R² = 0.936). This figure shows that as duration enrolled in CHIP increased, so did pregnancy and child nutrition knowledge scores. Self-efficacy, defined as participants’ confidence in making nutrition-related choices, was modestly but positively correlated with knowledge. This relationship was slightly stronger for young child nutrition (Figure 3, R² = 0.106) compared to pregnancy (Figure 2, R² = 0.054), suggesting that while efficacy supports knowledge gains in both areas, pregnancy-specific knowledge may need additional reinforcement. Within our sample, 39 gave quantifiable data concerning their nutrition and exercise habits. Our sample consumed an average of 4.8 servings of fruits and vegetables per week, while the recommendation is 5 servings per day [5]. Additionally, participants exercise on average 2 times per week for at least 20 minutes each time. Participants were asked what they prioritize when buying food, with responses rated on a scale from most unhealthy (1) to most healthy (5). Twenty-five participants provided quantifiable answers, with an average healthy eating score of 3.5.

Figure 2: Pregnancy Nutrition Self Efficacy vs Nutrition Knowledge.

Scatter plot showing individual participants’ pregnancy self efficacy (KAP scores) versus their nutrition knowledge scores. A linear trendline is included, with R² = 0.054, indicating a very weak positive relationship.

Figure 3: Young Children Nutrition Self-Efficacy and Nutrition Knowledge Scatter plot showing individual participants’ child self-efficacy (KAP scores) versus their nutrition knowledge scores. A linear trendline is included, with R² = 0.106, indicating a weak positive relationship.

Figure 1: Mean Pregnancy and Child Nutrition Knowledge Scores by Program Duration Bars represent the mean scores, and error bars indicate standard error of the mean. Linear trendlines are overlaid for each group, with R² = 0.936 for pregnancy nutrition scores and R² = 0.519 for child nutrition scores, indicating a strong positive relationship for pregnancy and a moderate positive relationship for child nutrition.

Table 1: KAP self-efficacy scores and nutrition knowledge scores for pregnancy and young children among CHIP participants, grouped by program duration. Early-term = 0 – 12 months, Medium-term = 13 – 24 months, Long-term = 24+ months. Values represent mean scores for each group.

Discussion

Recommendations for improving maternal health literacy include expanding community-based maternal health education, increasing access to pregnancy care in rural areas, and enhancing health communication strategies. Integrating health literacy programs for mothers, such as CHIP, could improve maternal and child health outcomes while also addressing the disparities faced by this population [1]. Our research has shown that CHIP’s efforts towards educating mothers on pregnancy and child nutrition knowledge has been effective. Although CHIP’s primary focus is targeted towards improving health outcomes and not specifically health literacy, our findings demonstrate encouraging trends. Our results show promising improvements in nutrition knowledge with modest but meaningful gains in health literacy as time enrolled CHIP progresses. These findings suggest that CHIP has the potential to extend its impact beyond direct services and help reduce gaps in maternal health literacy.

References

1. Angley M, Thorsten VR, Drews-Botsch C, et al. Association of participation in a supplemental nutrition program with stillbirth by race, ethnicity, and maternal characteristics. BMC Pregnancy Childbirth. 2018;18(1):306. Published 2018 Jul 24. doi:10.1186/s12884-018-1920-0 2. Department of Medical Assistance Services. 2022 – 23 Child Welfare Focus Study Report. Commonwealth of Virginia; 2023. Accessed March 27, 2025. https://www.dmas.virginia.gov/media/vuievjjb/2022-2023-child-welfare-focus-study. 3. Ferguson B. Health literacy and health disparities: the role they play in maternal and child health. Nurs Women’s Health . 2008;12(4):286 – 298. doi: 10.1111/j.1751-486X.2008.00343.x 4. Jiregna B, Amare M, Dinku M, Nigatu D, Desalegn D. Women Health Literacy and Associated Factors on Women and Child Health Care in Ilu Ababor Public Health Facilities, Ethiopia. Int J Womens Health . 2024;16:143-152 1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020 – 2025. 9th ed., Dec. 2020, www.dietaryguidelines.gov/sites/default/files/2020 12/Dietary_Guidelines_for_Americans_2020-2025.pdf We thank the participants and staff of the Childhood Health Improvement Program (CHIP) of New River Valley for their collaboration. This study was determined to be exempt by the Edward Via College of Osteopathic Medicine Institutional Review Board (IRB Record #2025-060; Approval Date: August 27, 2025, Exemption Category 2). Acknowledgements