KB Research Presented at SBM – Part 1

KB Research Presented at SBM – Part 1

Dr. David Buller from Klein Buendel presented two posters at the 46th Annual Sessions and Meeting of the Society of Behavioral Medicine in San Francisco, California, March 26-29, 2025. He was also a co-author on a third poster.

*Klein Buendel authors are bolded.

Poster 1

Title: Economic Evaluation of Two Scalability Strategies for Nationwide Dissemination of an Occupational Sun Safety Intervention

Dr. David Buller

Presenter: David Buller

Authors: Richard Meenan, David Buller, Julia Berteletti, Kimberly Henry, Mary Buller, Gary Cutter, Irene Adjei, and Noah Chirico

Americans spend many hours in work environments that contribute to health risks through hazardous job exposures. An economic evaluation of two methods for scaling up the Go Sun Smart at Work (GSS@W) evidence-based occupational sun protection program to prevent skin cancer in a nationwide transportation industry was conducted. GSS@W promoted employer adoption of sun protection policies and employee use of personal sun protection.

Cost-effectiveness analysis compared digital and in-person scalability strategies for disseminating the GSS@W program in a prospective two-group randomized trial. Regional districts (n=138) in 21 state Departments of Transportation (DOT) throughout the United States were recruited. District managers were assessed before and after scale-up and employees were posttest only. GSS@W was disseminated to managers at DOT districts either via an in-person scalability strategy with face-to-face on-site meetings and employee training or a digital scalability strategy with virtual meetings and online training. Cost of delivering GSS@W was obtained from project accounting records and manager reports on number and associated costs of implemented sun protection actions. Primary cost analysis was incremental cost-effectiveness ratio (ICER) between digital and in-person strategies, using program delivery cost as numerator and number of implemented sun protection actions as denominator. Secondary analysis summarized cost of implemented sun protection actions as reported by participating districts.

Mean implemented actions per district were 6.23 in digital and 6.53 in in-person strategy groups. Program delivery costs were estimated to be $15,658 for the digital strategy and $74,275 for the in-person strategy. Across all districts, the ICER was $3,305, representing average cost savings from an action not implemented under the digital strategy but implemented under the in-person strategy. Training was the most expensive action implemented by districts under either strategy (88% of implemented action costs).

The digital scalability strategy was cost-effective relative to an in-person strategy, generating substantial cost savings and offsetting a lower mean number of implemented GSS@W program actions. The GSS@W intervention may be readily implemented within employers that manage large annual budgets. Cost analysis was limited by not assessing induced costs to employees and potential feedback effects that could produce contamination.

The research was supported by a Cancer Moonshot Initiative grant from the National Cancer Institute (CA210259; Dr. David Buller, Principal Investigator). 

Poster 2

Title: Pilot Test of a Social Media Campaign on Preventing Cancer Risk Factors for Emerging Adults in Rural Communities in the American Mountain West

Presenter: David Buller

Authors: David Buller, Andrew Sussman, Echo Warner, Alishia Kinsey, Barbara Walkosz, Judith Gordon, W. Gill Woodall, Douglas Taren, Deanna Kepka, Kimberly L. Henry, Kayla Nuss, Cindy Blair, Evelinn Borrayo, David Wetter, Meghan Skiba, Julia Berteletti, Annelise Small, Dolores Guest, and John Torres

A social media campaign on preventing six cancer risk factors – being physical inactive, eating an unhealthy diet, using nicotine products, binging alcohol, being sunburned, and being unvaccinated for human papillomavirus (HPV) – was pilot-tested with emerging adults aged 18-26 living in rural counties.

Using an integrated theoretical framework, social media posts were developed to counter the cancer risk factors. Posts covered simplicity, benefits, response efficacy/cost, self-efficacy/perceived control, risk perceptions, norms, social support/relatedness, goals/values compatibility, intrinsic/extrinsic motivation, media literacy, and communication with family/friends. Twenty-six (26) emerging adults aged 18-26 living in rural counties in Arizona, Colorado, New Mexico, and Utah received a 4-week social media feed with 64 posts delivered in a private Facebook group. Emerging adults completed pretest and posttest surveys, and engagement (views, reactions, comments) was recorded.

Participants were 85% female and 35% Hispanic, with a median age of 23. At pretest, emerging adults demonstrated cancer risk factors: 53% engaged in <150 minutes of moderate-to-vigorous physical activity weekly, 85% had low daily intake of fruits and vegetables, 35% used nicotine products, 58% binged alcohol, 65% were sunburned, and 38% were unvaccinated for HPV. The campaign feed received 1,060 views, 346 reactions and 72 comments. Of the six cancer risk factors, posts on physical activity received the most views (216 views) while those on HPV and sun safety, the least (115 views each). Posts on physical activity, nicotine products, and alcohol received the most reactions (>50 reactions each) and physical activity and diet posts received the most comments (>9 comments each).

Social media is a popular source for health information among emerging adults. A multi-risk factor social media campaign has potential to engage emerging adults with theory-based cancer prevention messaging. The campaign will be evaluated in a randomized trial in 2025.

The research is supported by a grant from the National Cancer Institute (CA268037; Dr. David Buller and Dr. Andrew Sussman, Multiple Principal Investigators). Dr. Sussman is from the University of New Mexico Comprehensive Cancer Center. Other collaborating investigators are from the University of Utah, the University of Arizona, the University of Colorado, and Colorado State University.  

Poster 3

Title: Association of Indoor Tanning State Laws and Other Contextual Factors with Burns from Indoor Tanning in a National Sample of US Young Adults

Presenter: Carolyn Heckman from Rutgers University

Authors: Carolyn Heckman, David Buller, Anna Mitarotondo, Daniel Gundersen, Marisa Tomaino, and Julia Berteletti

Indoor tanning by minors is a significant risk factor for the development of melanoma. In addition to FDA safety regulations, 46 states restrict minor indoor tanning access by minors to prevent acute (burns from UV exposure) and chronic (skin cancer) harms. This study’s purpose was to identify state policy and other contextual factors associated with burns from indoor tanning to inform state policy efforts.

The authors conducted an online, nationally representative survey of individuals aged 18-29 who indoor tanned in the last three years (N=1000). Respondents reported on indoor tanning as adults (age 18 or older) and as minors (under age 18). Stringency of state laws on indoor tanning use by minors was scored, with no laws regulating minor indoor tanning being a “0” and laws banning all minors under 18 from indoor tanning being a “10.” Generalized linear models were used to estimate the associations of policy stringency for minor use and enforcement, indoor tanning behavior, and other contextual factors with burns after indoor tanning as a minor or adult. All analyses used the sampling weights.

Eighty-eight percent (88%) of participants reported engaging in indoor tanning in multiple facility types in the last three years, including indoor tanning salons, gyms, beauty salons, homes, spas, and apartments. Stringency of indoor tanning laws in participants’ home states were coded as an average of 4 (weak) out of 10. Fifty-seven percent (57%) of participants reported burning one or more times from indoor tanning in the past three years, with 14% from their most recent indoor tanning session. Correlates of burns from indoor tanning when a minor were weaker age restrictions, greater enforcement, more binge drinking, tanning at locales other than an indoor tanning salon, more sessions, shorter sessions, and more sunburns. Correlates of burns from indoor tanning when an adult were being between 22-25 years old, lower perceived indoor tanning facility safety in their state, greater enforcement, more sessions, and more sunburns.

This is the first study to investigate the impact of the stringency and enforcement of age restrictions in state indoor tanning law on burns both for indoor tanning before and after age 18, in a representative national sample. Burns were very common in the context of weak laws in many states, yet harmful burns after indoor tanning during childhood appeared to be lower in states with stronger age restrictions. Enforcing weak laws or inadequate safety regulations/compliance appears to have little impact on indoor tanning or burns in minors or adults. Thus, increasing stringency of state indoor tanning laws for all facility types may ultimately decrease acute harm and subsequent skin cancer rates.

This research was supported by a grant to Rutgers University from the National Cancer Institute (CA244370; Dr. Carolyn Heckman and Dr. David Buller, Multiple Principal Investigators).

Content Analysis of Posts Featuring Popular Instagram Fitness and Exercise Trends

Content Analysis of Posts Featuring Popular Instagram Fitness and Exercise Trends

Four main health and wellness trends have emerged on social media over the past several years: thinspiration, fitspiration, body positivity, and body neutrality. Thinspiration is intended to inspire consumers to obtain a very thin body and is often considered to be promoting disordered eating behavior. Fitspiration intends to inspire consumers to participate in exercise and aspire to a “fit” body. Body positivity promotes acceptance and appreciation of all body types and body neutrality prioritizes the function of the body, rather than its appearance. The content of body neutrality posts has gone largely unexamined, and no study has comparatively examined the content of fitspiration, body positivity, and body neutrality – until now.

Dr. Kayla Nuss, Klein Buendel Scientist, and her co-authors have published new data on the content of Instagram posts pertaining to exercise in the journal, Psychology of Popular Media. The paper is entitled, “What’s in a Hashtag? A Comparative Content Analysis of Fitspiration, Body Positivity, and Body Neutrality Posts on Instagram.”

The research team conducted a comparative analysis of 200 Instagram posts from three categories: fitspiration, body positivity, and body neutrality. There were 605 total posts. All content types featured mostly White women, although fitspiration featured slightly more racial diversity. Most people featured in fitspiration and body positivity posts were thin whereas the majority of those in body neutrality posts were of average body size. Commercialization was the most prominent message in all three content types and weight loss was featured often in both fitspiration and body positivity posts.

Based on these results, the authors conclude that body positivity has seemingly drifted away from its original intention and body neutrality now seems aligned with the origins of body positivity. Full descriptions of the study design, methods, results, and limitations are provided in the Psychology of Popular Media publication. In the paper, the authors offer recommendations for researchers to develop social media health behavior interventions using elements of these popular content types.

This research was sponsored by Klein Buendel and led by Dr. Kayla Nuss. Her collaborators included Julia Berteletti, Dr. Barbara Walkosz, Irene Adjei, Annelise Small, Liliana Salcido Beltran, and Noah Chirico from Klein Buendel; Anne Poirier from Shaping Perspectives in South Carolina; and Dr. Danielle Arigo from Rowan University in New Jersey.

STAC-T Usability Testing Results

STAC-T Usability Testing Results

A research team from Boise State University and Klein Buendel have published a paper in JMIR Human Factors entitled, “Usability Testing of a Bystander Bullying Intervention App (STAC-T) for Rural Middle Schools: A Mixed-Methods Study.” The paper reports on the conduct and outcomes of the usability testing of a bystander bullying intervention app for rural middle school students.

Students who are targets of bullying are at high risk for negative mental health outcomes including depression, anxiety, and suicidal ideation. Implementing school-based bullying prevention programs reduces bullying. Bullying prevention programs are particularly important in rural schools, as bullying is more prevalent in rural schools compared to urban schools. Comprehensive, school-wide bullying prevention programs, however, require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce some of these implementation barriers, the development of a technology-based program to address bullying increases access to bullying prevention for students in rural settings.

This study assessed the usability and acceptability of the STAC-T app and differences in usability between school personnel and students. Qualitative feedback related to usability, program features, and feasibility was also obtained and analyzed. A sample of 21 participants (10 school personnel and 11 students) recruited from two middle schools in rural, low-income communities in two states completed usability testing followed by a qualitative interview. We used descriptive statistics and independent sample t-tests to assess usability and program satisfaction. We used consensual qualitative research (CQR) as a framework to extract themes related to usefulness, relevance, needs, barriers, and feedback for intervention development.

Usability testing indicated the app was easy to use, acceptable, and feasible. Both school personnel and students rated the app well above the standard cutoff score for above-average usability (68.0) and both school personnel and students gave the app high user-friendliness ratings (0-7 scale, with 7 high user-friendliness). Overall ratings also suggested school personnel and students were satisfied with the program. Among school personnel, 100% said they would recommend the program to others and 10%, 50%, and 40% rated the program as 3, 4, and 5 stars, respectively. Among students, 90.9% said they would recommend the program to others and 27.3% and 72.7% rated the program as 4 stars and 5 stars, respectively. There were no statistically significant differences in ratings between school personnel and students.

Qualitative data revealed that both school personnel and students found the STAC-T app useful, relevant, and appropriate, while providing feedback related to the importance of narration of the text and the need for teacher and parent trainings to accompany the student program. Data also showed school personnel and students would find a tracker useful, in which students could report the different types of bullying they witnessed and strategies they used to intervene. Data from school personnel also indicated the program was perceived as practical and very likely to be adopted by schools, with time, cost, and accessibility being noted as potential barriers for schools in rural communities. The results demonstrate high usability and acceptability of the STAC-T app and provide support for implementing a full-scale randomized controlled trial to test the efficacy of STAC-T.

This research is funded by an STTR Phase II grant to Klein Buendel from the National Institute on Minority Health and Health Disparities at the National Institutes of Health (MD014943; Dr. Aida Midgett, Principal Investigator, Boise State University). Co-authors include Dr. Diana Doumas, Dr. Claudia Peralta, and Dr. Blaine Reilly from Boise State University; Dr. Matthew Peck from the University of Arkansas; and Ms. Mary Buller from Klein Buendel. The STAC-T modules were graphically designed and programmed by Klein Buendel’s Creative Team.

Designing Characters for a Middle School Anti-Bullying Program

Designing Characters for a Middle School Anti-Bullying Program

The use of avatars in video games and apps is creative and popular. “As both a visual representation of the gamer as well as a means of facilitating manipulation of a virtual world, an avatar can be seen as a means through which an individual is able to project their physical world self into a game world” (1). Avatars can help draw the user into the scenario (or virtual world) by making it seem more personal, relatable, and engaging.

Klein Buendel investigators, collaborators, and designers are employing human-depicted avatars in the development of STAC-T. STAC-T is a brief, web-based bystander anti-bullying intervention for middle school students. The training teaches students four distinct behavioral strategies: “Stealing the Show,” “Turning it Over,” “Accompanying Others,” and “Coaching Compassion.”   

The design of 72 characters for anti-bullying scenarios by Klein Buendel developer and illustrator, Peter Fu, was guided by a matrix to provide multiple choices for middle school students representing light, medium, and dark skin tones, races, and ethnicities. In addition, the characters depict varied hair styles in short, medium, and long lengths for student self-identification, and yet similar clothing to de-emphasize comparison, peer pressure, and stigmatization.  

Examples of STAC-T Avatars

© 2024 Klein Buendel

STAC-T was developed and assessed by a research team from Boise State University, the University of Arkansas, and Klein Buendel. The STAC-T project is funded by an STTR grant to Klein Buendel from the National Institute on Minority Health and Health Disparities at the National Institutes of Health (MD014943; Dr. Aida Midgett, Principal Investigator from Boise State University). Mary Buller from Klein Buendel is a Co-Investigator on the project. STAC-T programming, graphic design, and illustration were done by Klein Buendel’s Creative Team.

References

  1. Ducheneaut, N., Wen, M. H., Yee, N., & Wadley, G. (2009). Body and mind: A study of avatar personalization in three virtual worlds. In Proceedings of the SIGCHI conference on human factors in computing systems (pp. 1151–1160). New York, NY: ACM Press. https://doi.org/10.1145/1518701.1518877
Design of a high-resistance inspiratory muscle strength training app

Design of a high-resistance inspiratory muscle strength training app

Dr. Kayla Nuss, Klein Buendel Scientist, and a collaborative research team from Klein Buendel and the University of Colorado Boulder have published a paper on the feasibility and design of a novel smartphone app to deliver blood pressure-lowering high-resistance inspiratory muscle strength training in the journal mHealth.

High-resistance inspiratory muscle strength training (IMST) is a time-efficient form of respiratory exercise shown to lower blood pressure in midlife and older adults (aged ≥50 years) in randomized controlled trials delivered in clinical research settings. The purpose of this study was to design a feasible and acceptable smartphone application (app) for independently delivering IMST for lowering blood pressure.

Two rounds of iterative focus groups comprised of midlife and older women and men with above-normal systolic blood pressure (self-reported ≥120 mmHg) were performed to gain feedback on interest in an IMST smartphone app and design features. Focus group results were analyzed using a Consensual Qualitative Research (CQR) coding and data analysis protocol. Clickable wireframes were developed based on focus group findings. The wireframes were then beta tested for usability and additional feedback from target users was obtained.

Among midlife and older adults, there was considerable interest in app-delivered IMST as a
lifestyle intervention for lowering blood pressure. Potential facilitators and barriers of use for a potential app also were uncovered. Furthermore, the app wireframes were found to be highly usable, indicating that the app is ready for full-scale programming. Detailed research methods, analyses, and results of this research are reported in the mHealth paper. In conclusion, the authors report that they have designed a feasible and acceptable smartphone app for independently delivering blood pressure-lowering IMST in midlife and older adults.

The research is supported by an STTR grant to Klein Buendel from the National Heart, Lung, and Blood Institute (HL167375; Dr. Douglas Seals, Principal Investigator, from the University of Colorado Boulder). The authors are Dr. Kayla Nuss, Amanda Brice, and Steven Fullmer from Klein Buendel; and Elizabeth Jones, CeAnn Udovich, Dr. Kaitlin Freeberg, Narissa McCarty, Dr. Douglas Seals, and Dr. Daniel Craighead from the Department of Integrative Physiology at University of Colorado Boulder.

Analysis of Indoor Tanning Legislation in the United States

Analysis of Indoor Tanning Legislation in the United States

Dr. David Buller, Klein Buendel Director of Research, and a national team of scientists, physicians, and attorneys, have published an article in the American Journal of Public Health that describes the progression, content, and stringency of state legislation regulating indoor tanning in the United States.

Skin cancer is a highly prevalent, potentially deadly, and expensive disease. Indoor tanning is a well-established cause of melanoma and keratinocyte (non-melanoma) carcinomas. In the most recent estimates, nearly 6% of adolescents and 5% of adults indoor tan. Most individuals begin indoor tanning as adolescents or young adults. Stringent state indoor tanning laws that include age bans for minors instead of just parental consent are associated with less indoor tanning.

For this study, trained research assistants used legal mapping methods to collect and code legislative bills on indoor tanning introduced in U.S. states, the District of Columbia, and Puerto Rico. The research aimed to (1) describe the progression of state indoor tanning legislation (enacted or failed); (2) detail the content and stringency of bills with special attention to whether bills banned indoor tanning by minors (individuals aged younger than 18 years (under-18 ban); and (3) explore the potential impact of political party affiliation of state government leadership when bills were proposed.

Between 1992 and 2023, 184 bills were introduced in 49 of 50 states and the District of Columbia (56 laws were enacted, and 126 bills failed). An under-18 ban was enacted in 22 states and the District of Columbia. Analyses calculated composite scores on the stringency of age restrictions and of warnings, operator requirements, and enforcement. The research team evaluated associations of the political party of the legislative sponsor and legislature majority. Specific methods, coding protocols, statistical analyses, results, conclusions, limitations, and public health implications are detailed in the American Journal of Public Health paper.

In many states, it took several years and proposed bills before a law on indoor tanning was enacted. Enacted bills were more stringent than failed bills. Party affiliation of the bill sponsor and legislature majority combined to affect bill passage and age restrictions. Increasing support for stringent regulations on indoor tanning is evident and may motivate other states or the federal government to prohibit minors from using indoor tanning facilities in an effort to improve health and prevent death.

This research was supported by a grant to Rutgers University from the National Cancer Institute (CA244370; Dr. Carolyn Heckman and Dr. David Buller, Multiple Principal Investigators). Paper authors include Dr. Carolyn Heckman, Ms. Anna Mitarotondo, and Mr. Kevin Schroth from Rutgers University; Mr. Alan Geller from Harvard University; Dr. Jerod Stapleton from the University of Kentucky; Ms. Samantha Guild from the AIM at Melanoma Foundation in Texas; Dr. Jeffrey Gershenwald from the MD Andersen Cancer Center at the University of Texas; Dr. Robert Dellavalle from the University of Minnesota; Dr. Sherry Pagoto from the University of Connecticut; and Dr. David Buller, Ms. Julia Berteletti and Ms. Irene Adjei from Klein Buendel.

Recruitment Challenges for Project SHINE

Recruitment Challenges for Project SHINE

Dr. David Buller, Klein Buendel Director of Research, is part of a multiple institution research team that published a paper on recruitment challenges for Project SHINE. The research team is led by Dr. Yelena Wu from the University of Utah and the Huntsman Cancer Institute. The paper entitled, “Challenges and lessons learned in recruiting participants for school-based disease prevention programs during COVID-19,” was published in Contemporary Clinical Trials.

Schools provide an ideal setting for delivery of disease prevention programs due to the ability to deliver health education and counseling, including health behavior interventions, to large numbers of students. However, the remote and hybrid learning models that arose during the COVID-19 pandemic created obstacles to these efforts. The Contemporary Clinical Trials paper provides insights on collaborating with schools to deliver disease prevention programming during the height of the COVID-19 pandemic, and in subsequent years. The authors illustrate recruitment and engagement strategies by drawing upon their research experiences engaging high schools in a school-based cancer prevention trial focused on sun safety.

Delivery of a cluster-randomized trial of a school-based skin cancer prevention program was initiated in the spring of 2020 at the onset of the COVID-19 pandemic in the United States. The authors present multilevel evaluation data on strategies used to reach schools remotely and share lessons learned that may inform similar approaches moving forward during times of crises.

Although the COVID-19 pandemic interrupted school-based recruitment for this trial, enrollment improved one year later and did not appear to differ between rural and urban schools. Recruitment strategies and trial-related procedures were modified to address new challenges brought about by the pandemic. Despite the COVID-19 crisis altering classrooms, disease prevention programming can continue to be offered within schools, given close community partnerships and new adaptations to the ways in which such programming and research are conducted.

This research is sponsored by the National Cancer Institute (Dr. Yelena Wu from the University of Utah and the Huntsman Cancer Institute, Principal Investigator). Dr. David Buller from Klein Buendel is a Co-Investigator.

2024 Research Highlights

2024 Research Highlights

Klein Buendel scientists and staff continued to pursue rigorous behavioral science research with multiple national and international collaborators to positively impact the health and safety of people’s lives. Our creative team designed and engineered engaging web-based programs for many of the projects.

In 2024, we started two new large research projects with current collaborators. We co-authored 11 papers published in peer-reviewed journals or published online ahead of print, including one in the American Journal of Public Health. We presented study results at five national or international conferences, including the 6th International Conference on UV and Skin Cancer Prevention in Brisbane, Australia, where we were awarded the Best Poster prize along with our research collaborator, Emory University.

In February, Dr. Gill Woodall gave a presentation at the University of New Mexico Comprehensive Cancer Center entitled, “Randomized Trials of HPV Vaccine Uptake Improvement in New Mexico: Web Apps for Parents and Young Adolescent Girls and Boys.”

In May, Dr. David Buller gave a presentation for the ACCORDS Dissemination and Implementation Science Program at the University of Colorado Anschutz Medical Campus. His presentation was entitled, “Novel Adaptation of an Evidence-based Occupational Sun Safety Program for Today’s Outdoor Worker.”

In October, Dr. David Buller was an invited presenter on a panel discussion on increasing scale-up research in cancer control, sponsored by the National Cancer Institute. His presentation was entitled “Using Technology to Scale-up and Occupational Sun Protection Program.” 

Projects Launched in 2024

  1. “Emotion Regulation Intervention to Prevent Substance Use Among Youth in the Child Welfare System.” An R61 award to Klein Buendel from the National Institute on Drug Abuse (DA059785; Dr. Chris Houck, Principal Investigator, Rhode Island Hospital). The primary Co-Investigator from Klein Buendel is Ms. Julia Berteletti.
  2. “Hybrid Delivery to Increase Access and Sustainability: Evaluating ezParent Implementation.” A Fast Track STTR grant to Klein Buendel from the National Institute (HD116627; Dr. Susan Breitenstein, Principal Investigator, Ohio State University). The primary Co-Investigator from Klein Buendel is Ms. Julia Berteletti.

2024 Publications*

  1. Woodall WG, Buller DB, Saltz R, Martinez L. Professional development to improve responsible beverage service training: formative research results and protocol for a randomized controlled trial. JMIR Res Protoc. 2024 Jan 24:13:e49680. doi: 10.2196/49680.
  2. Breitenstein SM, Berteletti J, Smoske S, Barger C, Tipps K, Helsabeck NP. Administrative dashboard for monitoring use of a web-Based parent training intervention: usability study. JMIR Form Res. 2024 Jan 30:8:e53439. doi: 10.2196/53439.
  3. Buller DB, Sussman AL, Thomson CA, Kepka D, Taren D, Henry KL, Warner EL, Walkosz BJ, Woodall GW, Nuss K, Blair CK, Guest DD, Borrayo EA, Gordon JS, Hatcher J, Wetter DW, Kinsey A, Jones CF, Yung AK, Christini K, Berteletti J, Torres JA, Perez EYB, Small A. #4Corners4Health social media cancer prevention campaign for emerging adults: protocol for a randomized stepped-wedge trial. JMIR Res Protoc. 2024 Feb 22:13:e50392. doi: 10.2196/50392.
  4. Wu YP, Stump TK, Hay JL, Buller DB, Jensen JD, Grossman D, Shen J, Haaland BA, Jones J, Tercyak KP. Protocol for a cluster-randomized trial of a school-based skin cancer preventive intervention for adolescents. Contemp Clin Trials. 2024 May:140:107494. doi: 10.1016/ j.cct.2024.107494.
  5. Hay JL, Wu Y, Schofield E, Kaphingst K, Sussman AL, Guest DD, Hunley K, Li Y, Buller DB, Berwick M. Exploring the role of cancer fatalism and engagement with skin cancer genetic information in diverse primary care patients. Psychooncology. 2024 Apr;33(4):e6331. doi: 10.1002/pon.6331.
  6. Buller DB, Woodall WG, Saltz R, Martinez L, Small A, Chirico N, Cutter GR. Sales to apparently intoxicated customers in three states with different histories of responsible beverage service training. J Stud Alcohol Drugs. 2024 May;85(3):312-321. doi: 10.15288/jsad.23-00258
  7. Kitt-Lewis E, Loeb SJ, Walkosz BJ, Olanreqaju SA, Herbeck B, Fullmer S. Just Care: usability testing of e-learning modules for peer caregivers living in prison. J Offender Rehabil. 2024 Jul;63(6):387-400. Doi: 10.1080/10509674.2024.2370289.
  8. Buller DB, Buller MK, Meenan R, Cutter GR, Berteletti J, Henry KL, Kinsey A, Adjei I, Chirico N. Implementation of an occupational sun safety intervention: comparison of two scalability strategies. J Occup Environ Med. 2024 Oct 10. doi: 10.1097/JOM.0000000000003248. Online ahead of print.
  9. Wu YP, Brunsgaard EK, Siniscalchi N, Stump T, Smith H, Grossman D, Jensen J, Buller DB, Hay JL, Shen J, Haaland BA, Tercyak KP. Challenges and lessons learned in recruiting participants for school-based disease prevention programs during COVID-19. Contemp Clin Trials Commun. 2024 Nov 24:42:101399. doi: 10.1016/j.conctc.2024.101399. eCollection 2024 Dec.
  10. McCrady BS, Woodall WG, Berteletti J, Starling R, Martinez L, Westerberg V, Brooks M, Starke T. Developing a smartphone web app to help DWI offenders and their families. J Subst Use Addict Treat. 2025 Jan:168:209565. doi: 10.1016/j.josat.2024.209565. Online ahead of print.
  11. Buller DB, Berteletti J, Heckman C, Schroth K, Geller AC, Stapleton JL, Adjei I, Mitarotondo A, Guild SR, Gershenwald JE, Dellavalle R, Pagoto S. Bills to Restrict Access to and Harm from Indoor Tanning Facilities in US State Legislatures, 1992–2023. Am J Public Health. Online ahead of print 10.2105/AJPH.2024.307894.

*KB investigators and staff are indicated in bold type

2024 Conference Presentations

Several presentations on research progress, procedures, analyses, and outcomes were given by Klein Buendel scientists, staff, and their collaborators at the following national and international conferences:

  • 45th Annual Meeting of the Society of Behavioral Medicine (March)
  • 36th Annual Scientific Sessions of the Eastern Nursing Research Society (April)
  • 47th Annual Scientific Meeting of the Research Society on Alcohol (June)
  • 6th International Conference on UV and Skin Cancer Prevention (September)
  • 36th International Papillomavirus Conference (November)

Klein Buendel and Emory University won Best Poster at the UV Conference in Australia for “Narrative Synthesis of Skin Cancer Prevention Interventions for Samples with High Proportions of Participants with Skin of Color in a Systematic Review.” The poster was presented by Ms. Irene Adjei from Klein Buendel.

Smartphone Web App for DWI Offenders and Families

Smartphone Web App for DWI Offenders and Families

Driving while intoxicated (DWI) results in significant morbidity and mortality. The use of vehicle ignition interlock devices decreases the risk of drinking and driving while installed, but DWI rates increase after the devices are removed. Dr. W. Gill Woodall, Klein Buendel Senior Scientist, and his research collaborators have developed and tested the B-SMART smartphone web app to continue to support offenders and their concerned family members after their ignition interlock devices have been removed. They have published their methods and results of usability testing online in the Journal of Substance Use and Addiction Treatment.

Formative data collection for app development occurred in two phases. Phase 1 included key informant interviews with DWI offenders and concerned family members, development of one app module, and usability testing. Phase 2 included focus groups with DWI offenders and concerned family members, development of three more app modules, and usability testing. The Bangor System Usability Scale was used to rate app usability and satisfaction.

Results of key informant interviews and focus groups indicated that offenders and family members lacked information and were frustrated by the ignition interlock device, experienced financial burden from the DWI and the device, viewed supportive communication and positive shared activities as important, and were positive about the app. The four modules developed were Life with Interlock, Supporting Changes in Drinking, Doing Things Together, and Effective Communication. Each module included an introduction, at least one interactive activity, a video, and text to summarize what was presented. The content of the app modules was written primarily for the concerned family members. Usability testing indicated that the B-SMART modules were easy to use and informative.

The paper published online in the Journal of Substance Use and Addiction Treatment details the research measures, methods, analyses. A diagram describes the flow for the features and design of the app. This careful formative work resulted in an app responsive to the concerns of DWI offenders with ignition interlock devices and their concerned family members.

The authors believe that harnessing the power of the family to help the offender maintain a pattern of driving when not impaired may yield longer, successful outcomes initiated by the ignition interlock device. A future paper will report the efficacy of the B-SMART app after its implementation and testing in a rigorous randomized trial.

This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA022850; Dr. W. Gill Woodall, Principal Investigator). Collaborators included Dr. Barbara McCrady, Dr. Randall Starling, and Dr. Vern Westerberg from the University of New Mexico; Mr. Thomas Starke from Impact DWI in Sante Fe, New Mexico; and Ms. Julia Berteletti, Ms. Marita Brooks, and Ms. Lila Martinez from Klein Buendel. The B-SMART app was developed by the Creative Team at Klein Buendel.

KB Scientists Present HPV Vaccination Research

KB Scientists Present HPV Vaccination Research

Two Klein Buendel scientists presented HPV vaccination research at the 36th International Papillomavirus Conference in Edinburgh, Scotland, November 12-15, 2024.

Poster 1

Title: HPV Vaccine Uptake Improvement for Adolescent Boys via a Mobile Web App:  TeenVac.org

Presenter: W. Gill Woodall, PhD

Authors: W. Gill Woodall, PhD; David Buller, PhD; Gregory Zimet PhD; Alberta Kong, MD, MPH; Jeannyfer Reither, MS; Lance Chilton, MD; Lila Martinez; Marita Brooks, MS; Noah Chirico, MPH; Tamar Ginnosar, PhD

Dr. Gill Woodall

Human Papillomavirus (HPV) vaccine uptake remains below the U.S. national goal of 80% series completion. Parental concerns and misinformation about the HPV vaccine’s efficacy and safety remain and may be addressed by digital interventions tailored to their concerns.

Based on a previous intervention focused on parents and adolescent daughters, a randomized controlled trial was conducted testing a mobile web app (TeenVac.org) for parents and their adolescent sons (ages 11-14 years), responsive to their concerns and encouraging HPV vaccination. Two hundred nine (209) participants were randomized to receive either the TeenVac app (n=100) or the standard CDC HPV vaccination pamphlet (n=109) online. Adolescent sons’ vaccination records were collected from the New Mexico vaccine registry at the end of the study.

Intent-to-treat and web usage analyses were conducted. Intent-to-treat analyses found that adolescent sons of parents who were randomized to the TeenVac app were significantly more likely to complete the HPV vaccination series than the CDC pamphlet comparison group. Web usage analysis determined that those parents in the TeenVac group who used the web app were significantly more likely to complete the HPV vaccination series than those in the CDC pamphlet group. Modules focused on nature of HPV, the vaccine, and who recommends it were most used, with average durations ranging from 84 to 122 seconds.

The TeenVac app had a meaningful impact on HPV vaccine shot completion, particularly among parents who used the web app. The study trial’s recruitment and implementation were affected by the COVID-19 pandemic, with 86% of parent-adolescent pairs recruited during this period. Despite these challenges, the results provide further evidence that digital interventions can improve vaccine uptake when focused on parents and sons’ vaccine-related concerns.

This research was funded by a grant from the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Collaborators were from the University of New Mexico, Indiana University, and Klein Buendel.

Poster 2

Title: Development of Social Media Posts Promoting HPV Vaccination to Emerging Adults in Rural Communities of the united States

Presenter: David Buller, PhD

Authors: David Buller, PhD; Andrew Sussman, PhD; Echo Warner, PhD; Alishia Kinsey; W. Gill Woodall, PhD; Deanna Kepka, PhD; Barbara Walkosz, PhD; Julia Berteletti, MSW; Annelise Small; Dolores Guest, PhD; John Torres

Dr. David Buller

HPV-related cancers are increasing in rural areas of the United States and HPV vaccination rates of emerging adults are low. A social media campaign promoting HPV vaccine uptake, along with five other cancer risk-reduction behaviors, is being developed for emerging adults aged 18-26 living in rural counties in the western United States. Campaign posts were pilot-tested with emerging adults (n=188) in surveys on appropriateness, relevance, and trustworthiness and likelihood of engaging with them (such as read, scroll past, react [such as like, sad, etc.], comment, and click on a shared link). Also, emerging adults (n=26) were enrolled in a 4-week study where they received HPV vaccination posts in a Facebook private group and engagement (such as views, reactions, comments) was recorded.

Initially, 36 posts on HPV vaccination were developed addressing simplicity, benefits, response efficacy/cost, self-efficacy/perceived control, cancer risk perceptions, norms, relatedness, compatibility with goals/values, and intrinsic/extrinsic motivation. Posts debunked common misinformation on HPV vaccines, stressed that unvaccinated emerging adults should get vaccinated, and advised emerging adults on how to discuss HPV vaccination with family and friends. Emerging adults evaluated seven HPV vaccination posts in the surveys and rated them as appropriate, relevant, and trustworthy. Two-thirds of emerging adults said they would read the posts, but also might scroll past them. Over one-third would click on a shared link or leave a reaction, but few would comment. In the 4-week study, seven HPV vaccination posts received 115 views, 26 reactions, and 2 comments (both positive).

Social media is a primary health information source for young adults. Posts promoting HPV vaccination based on health behavior theories can reach and engage emerging adults with HPV vaccine-supportive messaging. The HPV posts will be included in a cancer prevention campaign evaluated in a randomized trial enrolling 1000 emerging adults in 2025.

This research was funded by a grant from the National Cancer Institute (CA268037; Dr. David Buller and Dr. Andrew Sussman, Multiple Principal Investigators). Collaborators were from the University of New Mexico Comprehensive Cancer Center, the University of Utah Huntsman Cancer Institute, and Klein Buendel.