CORE Posters Fall 2025

Increasing Awareness of Tick-Borne Diseases in Students: Development and Testing of a Library of Tick-Borne Diseases in Southwest Virginia

Fact Sheet

Olivia Hess, MPH, Meghan Sonnek, BS, Laurel Ness, MS, Roya Hazraty, BS, Garrett Toms, MS, Sam Bergman, BS, Kaity Hockenberry, BS, Luke Waits, BS, Jenny Hall, PhD, Jessica Nicholson, MAT, and Bernard Kadio, MD, MPH, PhD

Edward Via College of Osteopathic Medicine, Blacksburg, Virginia, Radford University, Radford, Virginia

Group L

Results

Conclusions

Abstract

Participant Demographics (N=65)

Background • Tick-borne diseases (Lyme, Ehrlichiosis/Anaplasmosis, Powassan) are rising in Virginia due to suburbanization and climate change. • Students are at-risk but rarely targeted with prevention-focused education. Purpose • Develop and test culturally relevant educational materials on tick-borne diseases for Montgomery County students. Methods • Two-phase, cross-sectional study. • Created a fact sheet, then conducted pre-/post-surveys. • Participants: n = 65 (DO n = 47, PhD n = 5, Master’s n = 7, Undergraduate n = 6). Results • Knowledge gains: Belief that Lyme is untreatable dropped from 25 (38.5%) to 3 (4.6%) (p < 0.001). • Awareness of lesser-known viruses rose from <5% to >80%. • Perceived effectiveness of repellents increased by 23%. • Most reported tick checks, but few used repellent/protective clothing. Conclusions • Tailored education improves student knowledge and awareness. • Behavior change (repellent, protective clothing) remains limited — further interventions needed. • Ticks are major vectors of Lyme disease, Ehrlichiosis/Anaplasmosis, and Powassan virus, which significantly affect public health in Virginia. 1,2 • Suburbanization and climate change have contributed to growing tick populations in the Appalachian region. 3,4 • The economic burden is substantial — Lyme disease alone costs the U.S. an estimated $345 – 968 million annually. 5 • In 2023, the Virginia Department of Health issued recommendations for education, surveillance, and prevention of tick-borne diseases. 2 • However, adoption of prevention behaviors remains limited, highlighting the need to understand barriers to consistent protection. • College and graduate students represent an at-risk group that has received little targeted education. • Study goal: Develop and evaluate educational materials on tick-borne diseases tailored to Montgomery County students, and assess changes in their knowledge, attitudes, and behaviors. Subjects • Sixty- five students participated: DO students (n = 47), PhD students (n = 5), master’s students (n = 7), and undergraduate students (n = 6). Protocol and Statistical Analysis • The study used a two-phase, cross-sectional design. • Phase I: Development of a culturally relevant fact sheet tailored to students. • Phase II: Pre- and post-surveys administered to assess knowledge, attitudes, and behaviors before and after reviewing the fact sheet. • Surveys were derived from previously published work. 6 • Surveys were anonymous and administered to students at Virginia Tech and VCOM VA. • Data analysis included descriptive statistics and the Wilcoxon signed-rank test to compare changes in knowledge, attitudes, and behaviors. • Reporting followed Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) standards, and ethical principles were guided by the Belmont framework of beneficence, respect, and justice. Introduction

Main Conclusions • Significant improvement in knowledge of tick-borne diseases was observed, particularly in: • Awareness of Lyme disease treatment options. • Recognition that Lyme disease is caused by a bacterium. • Belief in the effectiveness of tick repellents increased, suggesting that well designed educational materials can shift attitudes toward prevention. • Overall, findings indicate that tailored education can play a meaningful role in strengthening awareness and prevention among students in Southwest Virginia. Limitations • The surveyed population was primarily graduate students in science/medicine related programs, who may already have higher baseline knowledge of health related topics than other college student populations • Results may not fully represent the broader undergraduate student population, who may face different barriers or knowledge gaps. • The study measured short-term knowledge and attitude change; long-term behavior adoption was not assessed. Future Directions • Expand surveys to include larger and more diverse undergraduate student groups to compare trends across educational levels. • Develop and test additional strategies — such as interactive workshops, peer-led campaigns, and digital outreach — to encourage consistent use of preventive behaviors. 1. Gebhardt, L. L., Madison-Antenucci, S., Kramer, L. D., & Kauffman, E. (2020). Emerging tick-borne diseases. Clinical Microbiology Reviews, 33 (2), e00083-18. https://doi.org/10.1128/CMR.00083-18 2. Shelton, K. (2023). Tick-borne disease in Virginia (House Document No. 2). Virginia Department of Health. https://rga.lis.virginia.gov/Published/2024/HD2/PDF 3. Eisen, L., & Eisen, R. J. (2023). Changes in the geographic distribution of the blacklegged tick, Ixodes scapularis , in the United States. Ticks and Tick-borne Diseases, 14 (6), 102233. https://doi.org/10.1016/j.ttbdis.2023.102233 4. Ogden, N. H., Radojević , M., Wu, X., Duvvuri, V. R., Leighton, P. A., & Wu, J. (2014). Estimated effects of projected climate change on the basic reproductive number of the Lyme disease vector Ixodes scapularis . Environmental Health Perspectives, 122 (6), 631 – 638. https://doi.org/10.1289/ehp.1307799 5. Hook, S. A., Jeon, S., Niesobecki, S. A., Hansen, A. P., Meek, J. I., Bjork, J. K. H., Dorr, F. M., … Hinckley, A. F. (2022). Economic burden of reported Lyme disease in high incidence areas, United States, 2014 – 2016. Emerging Infectious Diseases, 28 (6), 1170 – 1179. https://doi.org/10.3201/eid2806.211335 6. Akuffo-Addo, W. (2024). Knowledge, attitudes, and practices towards tick-borne diseases among university students [Master's thesis, Lithuanian University of Health Sciences]. Lithuanian University of Health Sciences Research Repository. https://portalcris.lsmuni.it/ References

• 47 participants were DO students (72.3%), 5 were PhD students (7.7%), 7 were Masters students (10.8%), and 6 were undergraduate students (9.2%) • Respondents were from 13 states and 8 countries, including the United States • Majority were from Virginia (n = 31, 47.7%)

Knowledge Assessment

• Pre-survey, very few individuals had heard of Heartland virus (n = 2, 3.1%), Powassan virus (n = 1, 1.5%), and Bourbon virus (n = 1, 1.5%) • 4.6% of respondents (n = 3) had not heard of any of the tick-borne diseases mentioned.

Wilcoxon Signed Rank Test

Number of Pairs

65

Z

5.2

Std. Error

69.4

SD of differences (Sd)

1.13

p value

< 0.001

Figure 1. Belief that Lyme Disease can be Treated with Antibiotics

Disease Awareness

Figure 2. Identification of Lyme Disease Causative Agent

Correctly identified cause of Lyme as a bacterium: • Pre-survey: 68% (n = 44) • Post-survey: 95% (n = 62)

Prevention Strategies

Wilcoxon Signed Rank Test

Number of Pairs

65

Z

4.81

Std. Error

69.4

Acknowledgments

SD of differences (Sd)

1.05

p value

< 0.001

We would like to thank Dr. Bernard Kadio, Dr. Jenny Hall, and Ms. Jessica Nicholson for their help and support on this project. VCOM-Virginia Institutional Review Board, 2025 061, Approved on August 29th, 2025.

Figure 3. Belief that Tick Repellants are Effective