Commonwealth Scholars Program

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  Dental Safety Net Patients’ Reflections on Their Dental Problems and Opportunities for Care

  Jenifer Euceda Nunez

  Introduction: Low-income and underserved populations have disproportionately more unmet oral health needs. This may reflect factors across the lifetime as well as current home hygiene and access to care. These experiences lead to dental care having personal impacts on their lives that oftentimes can lead to personal opinions and stories. Their opinions and stories can provide insight to new themes that are not found within the existing limited literature. Steering away from a technical view on oral health research, personal perspectives can provide a new approach to oral health utilization that can further expand the limited existing literature. Objective: To identify findings related to dental safety net patients’ experiences of their oral health and dental care that are not already reflected in the literature. Methods: Using an iterative process, we identified deductive codes from the existing literature on oral health disparities and utilization and inductive codes found within interview recordings and recording transcripts from interviews conducted among participants who obtain services at federally qualified health center (FQHC) in Richmond, Virginia (n=29). This poster explores a new theme not previously well-documented in the literature.

  Results: Numerous Latinx patients reflected on their lifetime acceptance of dental problems, their gratitude for treatment opportunities at the FQHC, and the role that their faith has played in their oral health experiences. Discussion: Frameworks and theories need to take into consideration the way patients perceive their oral health experiences, for example through spirituality and cultural methods. Patients have strong cultural beliefs and methods that play a big role in their health and decision-making. Safety net providers should give equal amounts of attention and appropriate care to all patients. Some patients noted that providers wouldn’t give them certain advice or care while others would state the opposite. Fear, as well as low-income, little to no resources, and waiting times for appointments were common reasons why a person might not visit a dentist.

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  Nonpharmacological Practices for Reducing Agitation in Persons with Dementia

  Meghan L. Farkas

  1 in 11 people aged 45 years and older experience subjective cognitive decline, with nearly a third identifying a decline in the ability to participate in social activities, work, or volunteering. There are twelve modifiable risk factors that can either increase or decrease an individual's possibility of developing Dementia. This can include excessive alcohol consumption, head injury, air pollution, lower education level, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and infrequent social contact. These modifiable risk factors may prevent or delay up to 40% of dementias. Furthermore, many risk factors cluster around inequalities, which occur particularly in Black, Asian, and minority ethic groups and in vulnerable populations. Of the individuals who develop dementia, they may experience behavioral and/or psychological symptoms, such as agitation, depression, apathy, aggression sleep changes, wandering, and psychosis. Therefore, pharmacological intervention has become the most used treatment for those with dementia, such as antidementia drugs, antidepressants, antipsychotics, mood stabilizers, and benzodiazapines. The purpose of this literature review is to determine the non-pharmacological interventions that may help in the reduction of agitation among persons with dementia, thus attempting to highlight alternative treatments that may be more beneficial than pharmacological interventions. In addition, this review examines living options for individuals with dementia, as well as the types of dementia care that are offered at such places. This includes assisted living facilities, long term care facilities or nursing homes, continuing care retirement communities, as well as adult day care centers in the Richmond area. As a result, it was determined that there are several psychosocial and physical interventions that may offer more benefits in reducing agitation among persons with dementia. However, many of these interventions are not offered at many places of living, such as assisted living facilities or conintuing care retirement communities. Thus posing further challenges in providing the best care for persons with dementia.

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  A proposal for a social dance intervention to improve health in older African Americans living in community settings

  Olivia M. Alsamadi

  A proposal for a social dance intervention to improve health in older African Americans living in community settings

  Olivia Alsamadi, Dept. of Dance & Choreography, with Dr. Ana Diallo, VCU School of Nursing

  Introduction: Older low-income African Americans are at high risk for health problems such as falls, hypertension, stress, and depression, partly due to limited physical activity. Despite the fact that most healthcare professionals prescribe exercise, older adults are likely to drop out of exercise programs or avoid them altogether due to multiple barriers, including lack of interest. Social dance interventions offer innovative solutions for introducing exercise to interested individuals seeking an alternative exercise program. Low-impact aerobic exercise from social dance, for instance, can help address some health problems afflicting older adults, such as mobility, balance, sleep, and gait patterns. Additionally, the endorphins released from the exercise in conjunction with social interaction can combat residents’ depression and social isolation experiences. Furthermore, offering the opportunity to engage in social dancing as exercise on-site eliminates transportation barriers that keep older adults from participation. As part of the VCU Institute for Inclusion, Inquiry and Innovation (iCubed) Health and Wellness Aging Core and in collaboration with the Richmond Health and Wellness Program (RHWP), our research team plans to work with senior residents of a low-income public housing building to assess the feasibility of introducing a social dance intervention to improve physical and mental health. Following implementation of the social dance intervention, it is hypothesized that there will be improvement in participant health and attitudes toward dance as physical activity. Methods: Ten residents will be recruited on a volunteer basis and then assessed by the occupational therapist on-site to determine whether this form of exercise is safe for this population. The research team will conduct surveys to assess residents’ past and current experiences and attitudes toward dancing, and their physical/mental health status. The research team will develop a social dance intervention based on residents’ feedback and tailored to their interests (e.g., line dancing). The proposed intervention will take place two times a week, each session lasting forty-five minutes, over a three-week period. Focus groups with the residents pre- and post-intervention will inform the development of this social dance intervention, as well as provide insight on their overall experience with said intervention. Data collected from the focus groups will be analyzed to determine how the participants’ attitudes about their health and physical activity change over the three weeks. Discussion: The research team hopes to find that the health of the subjects will improve after the intervention as well as their attitudes about their health. This can be tracked through the surveys that are taken before and after the intervention, and the responses given in the focus groups. The research team also hopes to see a new sense of community with the residents in this new group activity that can continue outside of the intervention. A possible limitation could be residents dropping out during the intervention, but we hope to prevent this by having the program onsite for the residents so it is easily accessible. Using social dance, we hope to create and foster a long-term relationship with the residents and sustained exercise and social interaction.

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  The Effect of Education on Knowledge of Dental Care and Hygiene in Adults

  Jenifer Euceda Nunez and Tatiana Kohlmann

  The Effect of Education on Knowledge of Dental Care and Hygiene in Adults

  Jenifer Euceda Nunez, Dept. of Homeland Security, with Dr. Sarah Raskin, L. Douglas Wilder School of Government and Public Affairs

  Introduction: Dental care and hygiene are a common worry and often overlooked by adults. It is paid less attention to due to dental problems not occurring as often as other medical conditions and simply not having the sufficient knowledge. Individuals’ lack of knowledge on dental care and hygiene may reflect other educational gaps. This study assessed the relationship between educational attainment and knowledge of oral health among a sample of low-income immigrants served at a free clinic in Richmond, Virginia. Methods: Patients from Crossover HealthCare Ministry clinics were recruited to complete a survey about their oral health experiences, quality of life, and knowledge, such as names of certain areas in the mouth, and what factors can cause certain diseases. Oral health knowledge was assessed using the Comprehensive Measure of Oral Health Knowledge, a 25-question instrument that has been validated in English and Spanish. The research team entered study data into a secure online research survey system, REDCap; data was analyzed using SAS. Participant recruitment and data collection are still ongoing. Initial analysis focuses on descriptive statistics using means (M)/standard deviations (SDs) or frequencies/relative frequencies to assess differences in oral health knowledge across educational attainment, using t-tests for continuous variables and chi square test for categorical variables. Results: We expect to see more incorrect answers from the CMOHK in individuals with lower levels of educational background. Conclusions: This study aids in understanding educational impact on dental care. If lower educational levels are associated with lower oral health knowledge as measured by incorrect answers they will have on the CMOHK, intervention for this group would be salient.

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  The Effect of Amitriptyline on Biomarkers Associated with Brain Health and Drug Metabolism

  Ashana Jackson, Bukola Odeniyi, and Omar Hassan

  The Effect of Amitriptyline on Biomarkers Associated with Brain Health and Drug Metabolism

  Ashana Jackson, Dept. of Psychology, Bukola Odeniyi, and Omar Hassan, with Dr. Elvin T. Price, VCU School of Pharmacy

  High anticholinergic drugs, like amitriptyline have been linked to dementia and other neurodegenerative diseases. Chronic use of high doses of amitriptyline can lead to a decrease in brain capabilities and even negative effects on short-term memory. Expression of different brain biomarkers are also linked to various cognitive decline: Decreased expressions of PPARG and CREB1 have been correlated with a decrease in the brain’s ability to protect against aging, and impaired spatial memory, respectively. Increased expression of CACNA1C has been negatively correlated with short term object recognition. Therefore, the study examined the effect of amitriptyline on brain biomarkers: CACNA1C, CREB1, and PPARG. Human astrocytes were grown and separated into three 6-well sample plates. Cell treatment groups were: ILB, Amitriptyline 50M, Amitriptyline 220M, ILB + Amitriptyline 50M and ILB + Amitriptyline 220M. The mRNA expression was measured using RT-PCR. The data was analyzed by graph pad prism and ANOVA with Sidak’s multiple comparison’s test.After exposure of astrocytes to both concentrations of amitriptyline, there was increased expression of the CANA1C and decreased PPARG. Exposure to 220M amitriptyline lead to decreased expression of CREB1, but amitriptyline at 50M lead to an increase in expression. Findings indicated that amitriptyline significantly increased expression and decreased expression of PPARG. Though, different concentrations had varying effects on CREB1. These results indicate that the cognitive decline linked to amitriptyline are likely the effects that this drug has on these genes.

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  Stakeholder Perceptions of Health Needs in Refugee Populations in the Greater Richmond Area

  Ashley Koo, Matt Tessama, Tatiana Brown, and Jay Lawson

  Stakeholder Perceptions of Health Needs in Refugee Populations in the Greater Richmond Area

  Ashley Koo, Depts. of Medical Anthropology and Chemistry, Matt Tessama, and Tatiana Brown, with Dr. Dina Garcia, Dept. of Health Behavior and Policy

  A refugee is a person outside of the country of his or her nationality who is unable or unwilling to return to that country because of persecution or a well-founded fear of persecution based on her race, religion, nationality, or membership in a certain social group. The United Nations High Commissioner on Refugees estimates that in 2018, approximately 22,500 refugees were resettled in the U.S. with 1,805 arrived in Virginia. Many of these refugees face multiple health challenges post-resettlement, particularly in oral health. Although these oral health needs are a recognized concern, there is very little information to support what the specific facilitators and barriers to dental care access is for this population. The long-term objective of this study is to identify the largest gaps in healthcare access for refugee populations, and plan an intervention to bridge these gaps through local clinics. The health and oral health needs of refugees post-resettlement can be determined through one-on-one semi-structured interviews with health liaisons. The participants will be recruited from a list of organizations involved in refugee resettlement and employment, including the Virginia Department of Health, Commonwealth Catholic Charities, ReEstablish Richmond and the International Rescue Committee. The interviews will allow stakeholders to share their experience serving the refugee community, their perspective on health needs that are present in this population and ideas on how to address these needs. The interviews will be audiotaped and then transcribed via research participants and stored in the password-protected MAXQDA software. There exists a link between dental/ oral health and overall health: untreated dental cavities can lead to cardiovascular issues and can be fatal. Intervention within the community is needed to increase healthcare access; analyzing stakeholder perspectives will allow greater understanding of what inequities exist for refugee populations in the Greater Richmond area.

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  Correlation of Acculturation in the U.S. and Oral Health Knowledge

  Silvia Manzano and Tatiana Kohlmann

  Abigail Manzano, Dept. of Kinesiology, and Tatiana Kohlmann, with Dr. Aderonke A. Akinkugbe, VCU School of Dentistry and Dr. Sarah Raskin, L. Douglas Wilder School

  Introduction: The United States (U.S.) is one of the top leading nations among developed countries, with the highest infant mortality rates, obesity rates, and chronic disease rates. Healthcare disparities and inequalities across the U.S. are becoming an increasing problem; low-income and minority families are regularly denied basic healthcare or simply cannot afford care. Thus, the current study assessed the relationship between time since settling in the U.S. and the oral health knowledge of a sample of low-income immigrants served at a free clinic in Richmond, Virginia. Methods: Patients from the CrossOver Healthcare Ministry clinics were recruited to measure reasons for dental disengagement. The staff at the clinics developed and provided a list of patients that have not been to the clinic in over a year or at all. Eligible participants were asked to complete a consent form and surveys on dental health status, socioeconomic status, and associated health conditions (e.g., chronic diseases, diabetes, etc.). Oral health knowledge was assessed using a validated instrument, the Comprehensive Measure of Oral Health Knowledge (CMOHK) that included a set of 25 questions designed to help understand the patient’s knowledge of dental health. Given that a majority of the patients that register with the CrossOver clinics are Latinx and Spanish-speaking individuals, the surveys were administered in both English and Spanish, depending on the patient’s preference. Responses from the surveys were entered into a protected, online research portal (REDCap) and will subsequently be analyzed using SAS. We plan to produce descriptive statistics using means and standard deviations or frequencies and relative frequencies and assess differences in oral health knowledge according to time since settling in the U.S. using t-tests or chi square tests. Results: Participant recruitment and data collection are still ongoing; however, I hypothesize that those that have accultured to the U.S. for more than 10 years would yield the highest CMOHK scores. Conclusions: Minorities and low-income individuals often neglect their own dental care needs for various reasons, this study will help us understand if length of stay in the U.S. affects oral health knowledge.

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  Medication Risk and Polypharmacy in Minority Older Adults

  Rusha Patel

  Medication Risk and Polypharmacy in Minority Older Adults

  Rusha Patel, Depts. of Biology and Chemistry, with Dr. Youssef Roman, VCU School of Pharmacy, Dr. Elvin Price, VCU School of Pharmacy, and Dr. Lana Sargent, VCU School of Nursing

  Introduction: Adverse drug events refer to an individual being harmed due to taking a medication. These risks can include side effects, damage to different organs, senses impairment and more. The older adult population has the highest risk for adverse drug events. Antibiotics and anticoagulants are some examples of medication that cause higher adverse events in the elderly. The Beer’s List also includes drugs and their possible side effects. Anticholinergic can cause confusion and dry mouth, anti-infective can cause pulmonary toxicity, and cardiovascular medication can cause damage to the nervous system and increase toxicity in other organs. These events are preventable with caution, but it is important to recognize which medications are taken and the possible interactions/risks for the elderly. The purpose of this study was to evaluate the number of high-risk medications used by older adults (age 60 and older) living in a low-income community-based housing. Participants included had no history of dementia, Alzheimer’s, or Lewy-body disease. Methods: Data will be collected at senior apartment buildings in the Richmond area and at the VCU Health Clinic through the Richmond Health and Wellness Program (RHWP) among Older Adults. Demographics analysis includes age, sex, race/ethnicity, and housing location. Variables considered in the model include; 1) Social Determinants of Health (SDH) as defined by income, race/ethnicity, and education; 2) Medication risk will be measured by polypharmacy >=5 medications, Anticholinergic burden (ACB) score, drug class, and number of medications on the Beer’s list. Polypharmacy numbers >=5 and >=7 were compared to see how much the difference would be significant. Results: Findings and study hypothesis focus on identifying number of individuals taking high risk medications. When the polypharmacy medication was compared using the chi square statistics, the results were significant with a p-value of 0.02. Conclusions: Study implications have an impact on older adult drug safety. With results being significant, it can be concluded that the number used to compare polypharmacy mattered for these results.

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  Stress and Positive Coping in Older Adults

  Jazzmin-Guy Swain

  Stress and Positive Coping in Older Adults

  Jazzmin-Guy Swain, Dept. of Exercise Science, with Dr. Faika Zanjani, Dept. of Gerontology

  Stress can become a huge health risk factor for older adults. Stress occurs when individuals experience demands or threats without sufficient resources to meet these demands or mitigate threats. Everyone has some form of the same stressor(s), money job/school, health and family, which are the main common stressors. In every population, if those stressors are prolonged the stress can become chronic and become detrimental to a person's health. The reason stress often becomes chronic is because individuals may not know how to overcome their stress. As individuals age their health can decline but the stress doesn't necessarily dissipate which then put older adults at increased risk of diseases. One stressor that the older adults uniquely experience is stress about their age. Older adults can experience stress related to worries about growing old, like potential declines in mobility, brain functioning,health, hearing and seeing, and ageism, discrimination against a person because of their old age. A way to address the effect that stress has on the older population is by giving advice on positive coping mechanisms. Introducing positive ways to manage stress can potentially have positive effects for reducing the stress, and also providing a positive viewpoint on aging and improving health. Accordingly, this study aims to obtain feedback on a developed positive coping poster. In collaboration with iCubed Health and Wellness Aging Core and Richmond Health and Wellness Program (RHWP), we implemented a survey to assess poster feedback and aging related stress levels to RHWP low-income senior housing resident population. Survey results will provide insight about the individual stress and how they feel about using positive coping mechanisms to cope with their own stress. The poster design, development, justification, and preliminary survey data from n=10 participants will be described and discussed to direct future health interventions.

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  The Socioeconomic and Policy Barriers to Refugee Health

  Matt Tessema

  The Socioeconomic Barriers and Policy Barriers to Refugee Health

  Matt Tessema, Dept. of Journalism, with Dr. Dina Garcia, Dept. of Health Behavior and Policy

  There are multiple barriers that make it difficult for refugees to get adequate healthcare and among their largest barriers is meeting their oral health needs. The goal of this study is to figure out what those barriers are, whether it is financial or educational, and how to address it. This will be determined through the use of qualitative data from our semi-structured interview questionnaire. Those that will be interviewed include the health liaisons of refugee camps and the refugees themselves. The subjects will come from the surrounding refugee resettlement camps in the Richmond, VA area. The questions will aim to identify the refugee oral health care habit and their concerns gauging how much knowledge they have around oral health. These interviews will be audiotaped. We will then qualitatively analyze our data.

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  Characteristics of Medicaid Dental Providers Who Provide Oral Health Services to Pregnant Women in Virginia

  Hasib Zaman

  Characteristics of Medicaid Dental Providers Who Provide Oral Health Services to Pregnant Women in Virginia

  Hasib Zaman, Depts. of Bioinformatics and Computer Science, with Dr. Shilipa Naavaal, VCU School of Dentistry

  Introduction: Medicaid is a federal program that provides health insurance for low-income adults, children, pregnant women, and elderly adults in the United States. Virginia expanded their Medicaid, both financially and demographically, in January 2019 and currently has 1,317,981 individuals enrolled in Medicaid, which is an increase of 39.7% from 2018; however, within this expansion, there was no increase in budget for dental Medicaid. Although there are programs, such as Smile for Children, that cater to the oral health of pregnant women, many women do not use the available opportunities due to limited awareness and accessibility of services, as well as cultural factors affecting the quality of service (e.g., linguistic differences). Furthermore, only 39% of dentists nationwide accept Medicaid and/or children's health insurance, which not only discourages young families from seeking oral healthcare, but also limits their accessibility to these vital services. In order to clarify oral healthcare disparities for pregnant women, this study will explore the characteristics of providers who participate in Medicaid and provide oral health services to pregnant women in Virginia. Findings can inform policy focused on improving Medicaid participation among dental providers. Methods: The 2015-2018 Medicaid provider data was obtained through the State Department of Medical Assistance Services. The license numbers of each provider were collected using a public License Lookup tool available through the Virginia Department of Health Professions (VDHP). Additional provider characteristics (i.e., gender, age, years in practice, location) will be requested from the VDHP. Descriptive analysis is done to explore the characteristics of Medicaid providers, to map the distribution in the state of Virginia . Results: Analyses revealed that most providers were located in the Eastern and Northern regions of Virginia’s health districts (55%). These regions have the greatest number of providers that were involved in Medicaid, as it is a very suburban area containing a vast variety of demographics. Following these regions, there are approximately 11% of the providers in the Central region. Furthermore, the Northwest and Southwest regions combined to make up for approximately 34% of providers. Further analysis will be conducted in order to determine the socio demographic context of the providers within these regions. Discussions: During pregnancy, there is an increase in hormones that can affect one’s body’s response to plaque which can lead to increased tooth decay or gum disease. Therefore, there is a need to improve dental providers' participation in Medicaid to improve oral health services among pregnant women. These results have implications for workforce growth and development. Our study results suggest disparities in the distribution of dental providers by various characteristics. Findings provide an overview of the distribution of Medicaid, oral health providers throughout Virginia, with a particular concentration in the Northern region. Additionally, with regions such as Eastern and Northwestern that have a higher percentile of women that do not speak English fluently while having more providers that tend to be caucasian , there are demographic barriers between the two parties that inhibit women from seeking services.

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  Community Engagement for Health and Wellness in Aging Populations: Institute for Inclusion, Inquiry, and Innovation (iCubed)

  Naziirah Vines

  The Virginia Commonwealth University (VCU) Institute for Inclusion, Inquiry and Innovation (iCubed) is a cutting-edge institute focused on creating collaborative connections between the university and Richmond through innovative academic and research programs. iCubed consists of six transdisciplinary cores which unite faculty members and students to work with key community members to develop holistic solutions to 21st century urban challenges. One of these cores, the Health and Wellness in Aging Populations (HWAP) core, was designed to educate and assist low-income older adults in becoming self-sufficient in navigating healthcare services. The HWAP core is centered within the Richmond Health and Wellness Program, an interprofessional care coordination and wellness service that serves Richmond’s low-income senior housing communities. As part of its inaugural mentorship program, iCubed created the Commonwealth Scholars Program (CSP) to pair academically talented undergraduate students with faculty members in the HWAP core to conduct research on aging populations in Richmond. As part of their responsibilities, the students were tasked with interviewing HWAP core faculty members to assess their perceptions of the core’s mission and progress. As such, the current study summarizes the findings from these interviews and offers guidelines for future directions.

  CSP conducted interviews with HWAP core faculty members (N=10) to establish a multiperspective vision of HWAP core objectives. Interviewed members come from the following VCU Departments: Family and Community Health Nursing/School of Nursing, Pharmacotherapy and Outcomes Science/School of Pharmacy, Family Medicine and Population Health/School of Medicine, Gerontology/School of Allied Health Professions, Adult Health and Nursing Systems, and Urban and Regional Studies, Planning/L. Douglas Wilder School of Government and Public Affairs. Each interview lasted approximately 10 minutes and was recorded into an electronic document. Themes from the interviews were identified and main themes are described. Coded themes indicated that the HWAP core aims to deliver care, offer education, and help aging clients navigate the healthcare system. Faculty members noted that HWAP core’s engagement with the community aims to build trust with community members and create lifelong partnerships. Findings indicated that the HWAP core has the potential to improve the quality of life for older adults and empower community members to maintain their independence and age in place. Future opportunities for the HWAP core include training older adults to become community health workers to be truly vested within the mission and actions of the core. In conclusion, the HWAP core aims to improve the lives of low-income older adults in Richmond and does so by connecting VCU researchers and students with community members.