Technology, Social Media and Behavior Change

Technology, Social Media and Behavior Change

Klein Buendel (KB) Senior Scientist, Dr. Valerie Myers, was an invited presenter at The Colorado Cancer Coalition Annual Symposium held November 8-9, 2018 in Lakewood, Colorado. The mission of the Coalition is to eliminate the burden of cancer in Colorado. This year’s symposium, Elevating Personalized Cancer Care in Colorado, shared updates on innovative cancer care in Colorado and provided education and networking opportunities for professionals who work in cancer prevention, control, treatment, and survivorship.

Dr. Myers spoke about Technology, Social Media and Behavior Change in a session on Using Technology and Social Media to Advance Your Mission. She addressed multiple types of mHealth and eHealth technologies and the research behind their use in implementing health behavior change programs. Using her active research project Caminemos Juntas as an example, she was able to showcase how a smartphone app like Caminemos Juntas can be used to help Latina women overcome barriers to physical activity.

Dr. Myers said, “The benefit of technologies and digital health tools is that they have the capacity to be used in the real world with real people. That is their appeal.” She also stressed the importance of the use of digital technologies saying, “People who normally wouldn’t have access to empirically based and theory driven interventions now have access to them, so it really promotes the ability for scale up. I think this is where individual clinical trial-based health and public health come together really well, because you can translate what’s been done in rigorous trials and get it to the people to see if you can move the needle on these health behaviors.”

In addition to its importance, Dr. Myers said that digital health technologies such as mHealth and eHealth are “the way to get interventions in the hands of people that may never have been exposed to this messaging. If it can reach those individuals who have been neglected traditionally by health intervention and also meet people in a place where they feel comfortable and safe and are ready for change, then that excites me.”

KB scientists and staff have been active members of the Colorado Cancer Coalition and its Skin Cancer Task Force for over a decade.

Nightlife Safety Research

Nightlife Safety Research

Dr. Brenda Miller from the Pacific Institute for Research and Evaluation (PIRE) gave a presentation at the 9th Conference and Members’ Meeting of the European Society for Prevention Research (EUSPR) in Lisbon, Portugal, October 24-26, 2018. EUSPR “promotes the development of prevention science, and its application to practice so as to promote human health and well-being through high quality research, evidence based interventions, policies, and practices.” The research presented by Dr. Miller was designed and conducted in collaboration with scientists and staff from Klein Buendel (KB).

The study of nightclub patrons and their social drinking groups, tests an intervention called Nightlife Safety Plans (NSP). NSP is designed to reduce escalation of overuse of alcohol and drugs, physical aggression, and sexual aggression during an evening at the club. NSP relies on social groups that arrive at the club together to identify early signs of problems and to take actions to intercede. The actions are: Outreach, Options, and Out.

Data analyzed in this presentation consisted of 352 groups (961 participants) gathered over 41 Friday and Saturday nights at seven different clubs in the Bay Area of California. Data from online surveys, alcohol breath tests, and biological drug tests (post-test only) were gathered at entrance and exit for pre- and post-test assessments of the intervention effects. Biological measures reveal at least one club patron per group was legally intoxicated (Breath Alcohol Concentration—BAC, >.08%) in 60% of groups and at least one patron was positive for drugs in 50% of the groups. Further, at least one club patron per group experienced physical and/or sexual aggression within 40% of the groups.

Results indicated that experimental groups were significantly more likely to intervene with group members, using a significantly higher number of intervention strategies (Outreach, Options, and Out), to assess situations for physical aggression and sexual harassment, and to respond to friends experiencing sexual harassment. Further, experimental groups used significantly more protective strategies to keep group members safe. Reduced levels of alcohol use and intoxication or impairment (BAC > .05), as assessed by breath tests, were found among the groups in the experimental as compared to the control condition.

In summary, groups provide an opportunity to deliver and implement peer-focused safety strategies to enhance safety during the time spent in the club. The research’s focus on clubs also reaches young adults who are working (two-thirds were not in college), whereas many of these types of interventions are targeted toward college students.

This research was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA022331; Dr. Brenda Miller, Principal Investigator). Collaborators included Veronica Rogers, Dr. Hilary Byrnes, Dr. Mark Johnson, and Dr. Joel Grube from PIRE; and Dr. David Buller and Julia Berteletti from KB.

 

Using Targeted Photographs to Improve Health Messages for Stigmatized Populations

Using Targeted Photographs to Improve Health Messages for Stigmatized Populations

In a recent e-publication in the Journal of Health Communication, Mary Buller, President of Klein Buendel (KB), and her coauthors report results of an evaluation of using Real Health Photos in health communication messaging. Real Health Photos is a unique collection of images of people with diversity of age, gender, race, ethnicity, income level, and health condition. The collection was produced by KB to portray the diversity of health through photography and promote the inclusion of all populations in health promotion materials and media.

Of particular concern is how to reach underserved populations with effective health messages. Underserved groups with particular health needs — including people with disabilities, the elderly, and the overweight or obese — are underrepresented in popular media images and are often stigmatized so that they have to deal with prejudice and ostracization.

This research project tested the prediction that photographs depicting people very similar to the target population of a health message would improve the health communication and increase the  target populations’ intentions to change behavior in a favorable, more healthful direction. The evaluation of using Real Health Photos in health communication messaging was guided by the homophily principle. The homophily principle — that perceived similarities among people produce positive reactions — is a cross-cultural, global phenomenon and is grounded in the power of identification. Specifically, the study tested two hypotheses: (1) whether a health communication message will be more effective (that is, create stronger behavioral intentions to increase physical activity and eat a healthy diet) when incorporating photographs that match the target population than photographs that do not match the population in disability, age, or weight; and (2) whether the effectiveness of photographs that match the population on disability, age, or weight will be mediated by identification with persons in the photographs (that is, matched photographs will increase identification relative to unmatched photographs and increased identification will be associated with greater behavioral intentions).

To test the hypotheses, three nationally-representative samples of adults (n=1,796) who were physically-disabled, elderly, or overweight/obese were selected from a large national survey panel. Participants read an identical message promoting increased moderate to vigorous physical activity and decreased intake of high fat, high sugar, and high carbohydrate foods. Photographs from a commercial stock photograph service versus photographs created for the research project to match the three populations — from Real Health Photos — were included in the messages. Participants responded to assessments of behavioral intentions, outcome and self-efficacy expectations, and identification. Statistical analysis confirmed that Real Health Photos that matched the specific target population increased behavioral intentions mediated by identification in the physically-disabled and overweight/obese samples. Matched visual images improved health message effectiveness by capitalizing on the homophily and identification processes.

The development of Real Health Photos and this research were funded by a Small Business Innovation Research grant from the National Institute of Minority Health and Health Disparities (MD003338; Mary Buller, Principal Investigator). Coauthors include Dr. Peter Andersen from San Diego State University, Dr. Michael Slater from The Ohio State University, Dr. Kim Henry from Colorado State University, Lyndsay Fluharty from Telligen, Inc., and Dr. Erwin Bettinghaus, Xia (Lucia) Liu, Steve Fullmer, and Dr. David Buller from KB.

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

Dr. Gregory Zimet is a Clinical Psychologist and Professor in the Department of Pediatrics at the Indiana University School of Medicine. Since he arrived there in 1993, he has guided an extensive, multi-faceted research program focused on attitudes about, and acceptance of, vaccines for the prevention of sexually-transmitted infections, including the human papillomavirus (HPV) vaccine.

Currently, Dr. Zimet serves as a KB collaborating scientist with Dr. Gill Woodall and Dr. David Buller on a research project entitled “Web App Technology for Boys and Parents: Improving HPV Vaccine Uptake.” Other collaborating investigators include Dr. Alberta Kong and Dr. Randall Starling from the University of New Mexico. The four-year HPV project, funded by a grant from the National Cancer Institute (CA210125; G. Woodall, PI), is designed to produce a mobile web app to accurately inform parents and adolescent boys about the HPV vaccination and address unique concerns about its safety and effectiveness for boys. The mobile web app is being developed for personal computers, smartphones, and tablet computers.

Dr. Zimet’s research also has involved randomized clinical trials designed to evaluate the effects of brief health communication messages on hepatitis B virus and HPV vaccine uptake, and on acceptance of HIV testing. Through his involvement over the past five years in the Adolescent Medicine Trials Network for HIV/AIDS Interventions, Dr. Zimet has expanded his research focus to examine factors related to recruitment of adolescents into biomedical HIV prevention clinical trials. Biomedical trials that may involve the recruitment of adolescents are related to pre-exposure prophylaxis, HIV vaccine, and microbicides. Some of his recent publications address HPV vaccination, microbicide acceptability among adolescents, and attitudes about HIV and herpes simplex virus type 2 testing.

Dr. Zimet has served as a research mentor to five physician fellows, over 20 pre- and post-doctoral fellows in psychology, social work, health behavior, and nursing, and several junior faculty in the Department of Pediatrics and the School of Nursing at Indiana University.

¡Caminemos Juntas!: A Smartphone App for Latinas to Connect with Walking Partners

¡Caminemos Juntas!: A Smartphone App for Latinas to Connect with Walking Partners

Dr. Valerie Myers, Klein Buendel (KB) Senior Scientist, is the Principal Investigator leading a new research project aimed at helping Latinas combat barriers to physical activity using smartphone technology and social networks.

Hispanic women are a growing and influential segment of the population, yet health disparities for Latinas remain high. Latinas are more likely than their non-Hispanic White counterparts to be overweight, diagnosed with diabetes, and physically inactive. Regular physical activity promotes physical and emotional well-being, such as lower risk of heart disease and diabetes, weight management, and improved quality of life, yet physical activity interventions for Latinas remain limited.

Community-focused walking interventions produce improvements in physical activity and are well-received by Latinas when they are socioculturally sensitive. New technology has the ability to provide Latinas with innovative ways to connect socially and increase PA. Location-based services (LBS) are a popular technology that uses geographical positioning to allow individuals to use their smartphones to connect to their surrounding environment.

¡Caminemos Juntas! is a physical activity walking app that uses location-based services to connect Latinas within nearby neighborhoods as a way to provide social support for increased walking behavior. A prototype of the ¡Caminemos Juntas! app was programmed for both iOS and Android smartphones in a previous Phase I project. Multi-method formative research was conducted to guide app design and content prior to conducting field usability testing. To guide prototype development, a national sample of Latinas (n=98; mean age 32.7 +/- 7.8 years; 45% primary Spanish speaking; 28.6% with annual income < $15,000) were surveyed to better understand their preferences, usage, needs, and obstacles of current apps in relation to health and physical activity. Latinas’ current physical activity behaviors and smartphone use, opinions on health-related apps using LBS, how often they access social networking sites on their mobile phone, and their likelihood of using a social networking app to connect to others with intentions to be physically active were also examined.

Phase I results revealed that 22.5% never or rarely exercised, 73.5% accessed social networking sites daily with an average of 8 times a day, and 43.9% used LBS every day. Ease of use (82%), informationally accurate (79.2%), and reliability (84.7%) were app features rated as highly important. Over 63% reported high likelihood of using a social networking app to connect to others with the intentions of being physically active, and 67.4% reported that this type of app would be very helpful. Focus groups showed that the app was appealing, also.

In the new Phase II project, the ¡Caminemos Juntas! app will be fully developed and evaluated in a randomized control trial with Latinas aged 18-45 in San Jose, CA and Denver, CO. Changes in physical activity, social support for exercise, and quality of life will be evaluated. New features to be explored include Fitbit® device integration, mapping of walks, and social media integration. The LBS features of the app will allow Latinas to determine a safe place to meet for a walk, connect with other users nearby, and be notified if there was an available walk in the user’s vicinity.

The research is funded by the National Institute on Minority Health and Health Disparities (MD009652) at the National Institutes of Health through the Small Business Innovation Research Program. Dr. Myers’ collaborators include Dr. Abby King from Stanford University, and Dr. Gary Cutter from Pythagorus, Inc. in Alabama.

Use of AFIX-based Strategies for HPV Vaccination in Florida

Use of AFIX-based Strategies for HPV Vaccination in Florida

Dr. Barbara Walkosz, a Senior Scientist at Klein Buendel (KB), is one of several authors on a recent publication reporting on Florida pediatricians’ use of AFIX-based strategies for human papillomavirus (HPV) vaccination of adolescents and young adults. The report is published in the journal Preventive Medicine. Research collaborators (coauthors) are from the Moffitt Cancer Center and Research Institute, the University of South Florida College of Medicine, Pediatric Partners, the Indiana University School of Medicine, and the Johns Hopkins University School of Public Health.

HPV vaccination is recommended by the U.S. Centers for Disease Control and Prevention (CDC) to significantly reduce the incidence of cervical, vaginal, oral, and other cancers caused by the sexually transmitted virus. A series of vaccinations are recommended for adolescents and young adults, preferably before the onset of sexual activity (9-26 years of age).

However, rates of HPV vaccination in Florida and the U.S. are disappointingly low – less than 50% for girls and less than 40% for boys. In an effort to increase HPV vaccination of pediatric patients, the CDC created and implements the AFIX quality improvement program with healthcare providers. AFIX stands for Assessment, Feedback, Incentives, and the exchange of information – the four key strategies of the program which is delivered to clinics by local health departments.

The Preventive Medicine paper reports on the results of a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida to assess the use of the AFIX strategies. Less than half of the physicians surveyed reported implementing any AFIX strategies, leaving room for program engagement, uptake, and improvement.

B-SMART Study Launches at KB

B-SMART Study Launches at KB

Klein Buendel (KB) Senior Scientist, Dr. Gill Woodall, is the Principal Investigator leading a new research project aimed at reducing intoxicated driving by people with court-ordered ignition interlock devices (IIDs) through improved communication and support from family members.

Driving while intoxicated (DWI) remains a substantial and preventable source of morbidity and mortality in the U.S. The IID, which requires a driver to blow into a breathalyzer unit installed in an automobile to establish sobriety, reduces drunk driving while installed. However, research has shown that once IIDs are removed from DWI offenders’ cars, DWI recidivism levels return to those comparable to offenders who did not have an IID installed.

This new project will fully develop and evaluate B-SMART — smartphone technology to teach coping skills, communication skills, and strategies to help deter DWI. Unique to this intervention are the involvement of family members in supporting the DWI offender to not drink and drive, English and Spanish language options, and the use of smartphone technology to make that support immediate, accessible, and diffusible. The core content of the intervention is based on empirically-validated couples therapy curriculum developed by Dr. Barbara McCrady from the University of New Mexico. It will be adapted for concerned DWI offender family members and delivered through a convenient smartphone web app platform. Programming and usability testing will be done by KB designers and developers.

Results of a Phase I feasibility study of an initial module of B-SMART presented at the Research Society on Alcoholism by Dr. Woodall in 2016, showed very positive reactions by users. Thirty-two concerned family members of DWI offenders browsed the communication skills module of B-SMART and then rated the module on the System Usability Scale (SUS – Bangor, et al., 2011). Results indicated an average SUS rating of 44.2 (sd=4.78, scale range: 10-50), with 87% of participants rating the B-SMART module 40 or above. These results indicate that users found the prototype B-SMART module easy to use, informative, and very positive.

For the new Phase II evaluation, a randomized efficacy trial will be conducted with DWI offenders and their concerned family members recruited through the New Mexico court system. The research is funded by the National Institute on Alcohol Abuse and Alcoholism (R44AA022850) through the Small Business Innovation Research Program. Dr. Woodall’s scientific collaborators include Ms. Julia Berteletti from KB, Dr. Barbara McCrady and Dr. Vern Westerberg from the University of New Mexico, and Dr. Gary Cutter from Pythagorus, Inc. in Alabama.

Pinpoint: A Pain Management Tool for Teens with Sickle Cell Disease

Pinpoint: A Pain Management Tool for Teens with Sickle Cell Disease

Klein Buendel (KB) Senior Scientist, Dr. Valerie Myers, is the Principal Investigator leading a new research project to improve a self-care and pain management tool for teens with Sickle Cell Disease (SCD). SCD is the most common inherited blood disorder in the U.S. It affects primarily African Americans and Hispanics. Approximately, 100,000 people in the U.S. suffer from SCD and serious, painful complications can have a significant impact on well-being and quality of life.

Using interactive technology accessible on computers, tablets, and smartphones, the Pinpoint app will combine education, healthy living tips, and tools for managing pain through at-home techniques like relaxation, self-reflection, and a better understanding of the different types of pain teens might experience (acute versus chronic pain).

In a Phase I project, an initial prototype of Pinpoint was developed and reviewed. It included a Pain Assessment Tool, vocabulary game, body scanner reflection, educational self-disclosure activity, and excerpts from the Hope and Destiny Jr. book authored by Hsu, Rodrigues, and Brandalise. Four healthcare providers were interviewed on the app’s acceptability and potential function within the clinical practice. Sixteen teens participated in cognitive interviews, focus groups, and usability testing. The System Usability Scale (SUS; Bangor et al., 2011), a validated tool for assessing the usability and acceptability of technological products, served as the primary outcome. The preliminary SUS score well above average, suggesting a high level of acceptability and usability among users.

The full Pinpoint app being developed in the new Phase II study can be used in healthcare settings to reduce barriers in obtaining information from adolescents by using technology they are comfortable with and enjoy using, while also providing important pain data to healthcare teams and family that affect treatment options. By empowering teens with knowledge and enhanced communication skills, Pinpoint can help reduce emergency room visits and assist SCD teens to transition more successfully to adulthood with independence.

The Pinpoint project is being funded by the National Institute on Minority Health and Health Disparities at the National Institutes of Health (MD010746). It is being conducted in close partnership with the Hilton Publishing Company (HPC), the publisher of Hope & Destiny Jr., a leading book for teens on SCD management. Dr. Myers’ research collaborators include Ms. Mary Buller from KB, Dr. Lewis Hsu from the University of Illinois, Mr. Allan Platt from Emory University in Georgia, Dr. Gary Cutter from Pythagorus, Inc. and the University of Alabama at Birmingham, and Dr. Hilton Hudson from HPC. KB’s developers will design and program the Pinpoint app.

Implementation and Effectiveness of an Online Responsible Vendor Training Program for Recreational Marijuana Stores

Implementation and Effectiveness of an Online Responsible Vendor Training Program for Recreational Marijuana Stores

Since 2012, nine U.S. States and the District of Columbia (DC) have legalized recreational marijuana, and several other states are looking to follow suit in coming years. At the outset of the legalization of recreational marijuana, the U.S. Department of Justice (DOJ) informed these states that they must put robust constraints into place that prevent youth access to marijuana. To accomplish this DOJ objective, Dr. David Buller and Dr. Gill Woodall from Klein Buendel (KB), and their co-authors created Train To Tend, an online responsible marijuana vendor (RMV) training program that aims to provide retail marijuana staff with the knowledge and skills they need in order to sell marijuana responsibly, and keep their communities safe. In a recent e-publication in the Journal of Public Health Management and Practice, the authors report the results of the implementation and evaluation of Train To Tend and what these results could mean for future research and policy.

Train To Tend was created with input from state regulators and local law enforcement personnel, curriculum standards published by the Colorado Marijuana Enforcement Division, interviews with recreational marijuana store personnel (n=15), and usability testing of a prototype training with store personnel (n=19) in Colorado and Washington State. Of all the input from these various stakeholders, retail marijuana store personnel reported that comprehensive training in responsible sales practices was uncommon in the industry. Coupled with the DOJ objective of preventing youth access to marijuana, this finding demonstrated a need for RMV.

Once all stakeholder input was reviewed, Train To Tend was created, and the training ultimately contained five modules: state laws and regulations, ID checking, health effects of marijuana, customer service practices including recognizing intoxicated patrons, and rules of the trade.

In a randomized controlled trial, the training was tested using a random sample of state-licensed recreational marijuana stores (n=225) in Colorado, Oregon, and Washington State. One hundred twenty-five stores were randomly selected to receive Train To Tend, while the remaining 100 stores received the usual and customary training in their state. In total, 420 store employees completed Train To Tend in 2017 and 2018. Pre- and post-training surveys were administered to Train To Tend trainees to gauge their perceptions of self-efficacy toward RMV practices, as well as their ratings of usability for Train To Tend.

Results revealed that the training improved trainees’ ability to check IDs, use their state’s inventory tracking system, and spot intoxicated customers. Also, most trainees felt very confident using the training, rated the training as user-friendly, and thought that the information and skills learned in the training would help keep their communities safe.

Overall, trainees’ improvement in confidence to engage in responsible sales practices, as well as the high levels of usability for Train To Tend they reported, suggests that programs like Train To Tend are feasible and potentially effective at training staff in recreational marijuana markets. In addition, this randomized-controlled trial provides a solid foundation upon which future research into RMV trainings can be built. This type of research is imperative to ensure the safety of customers that live in early-adopting recreational marijuana markets like Colorado, Oregon, and Washington State. By conducting research like this when recreational marijuana legalization is in its early stages, many unforeseen problems can be mitigated before they grow too large, and ultimately the public can be kept safer.

This research was funded by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Coauthors include Dr. Gill Woodall, Mr. Andy Grayson, and Ms. Mary Buller from KB, and Dr. Robert Saltz from the Pacific Institute for Research and Evaluation.

Way to Serve Tops 75,000 Trainings

Way to Serve Tops 75,000 Trainings

WayToServe®an evidence-based online responsible alcohol server training program, has achieved a significant milestone by surpassing 75,000 completed trainings. The program, developed by scientists at Klein Buendel, Inc. (KB), the University of New Mexico (UNM), and the Pacific Institute for Research and Evaluation, was initially evaluated in a controlled randomized trial that resulted in increased refusal of sales to intoxicated patrons. WayToServe® was then transferred from its research phase to commercialization in 2012. It was licensed to Wedge Communications LLC for marketing and distribution initially in New Mexico for training of on- and off-site alcohol servers.

Additional state-specific versions of WayToServe® have been created that conform to the Responsible Beverage Service curriculum requirements of the State of California, the Texas Alcoholic Beverage Commission, Washington State Liquor Control Board, and Oregon Liquor Control Commission. WayToServe® is now sold in California, New Mexico, Texas, and Washington. The Spanish version, WayToServe Español, is scheduled to be tested in New Mexico and Texas later this year.

Commenting on the milestone achievement, Dr. David Buller, KB Director of Research and WayToServe® Co-Investigator, said “Plans are underway to refresh the entire online training for the next 75,000 servers to learn to sell alcohol responsibly and keep their customers and communities safe.”

The creation and evaluation of the original WayToServe® program was sponsored by two grants from National Institutes of Health to UNM (Dr. W. Gill Woodall, Principal Investigator). The WayToServe Español research project is being funded by a Small Business Innovative Research (SBIR) grant to KB from the National Institute of Minority Health and Health Disparities (R44MD010405; Dr. W. Gill Woodall, KB Senior Scientist, Principal Investigator).