Association of Occupational Sun Safety Policy with Employee Practices

Association of Occupational Sun Safety Policy with Employee Practices

Occupational sun protection policies are fundamental for the increased implementation of employee sun safety practices. Investigators and staff from Klein Buendel, led by Dr. David Buller, Director of Research, recently published baseline results from a large-scale workplace sun safety policy project in the American Journal of Industrial Medicine.

In the publication, the authors report on the coding and evaluation of written safety policies from 21 state Departments of Transportation (DOTs) enrolled in a randomized trial testing methods for scaling-up an occupational sun safety intervention. A total of 1,113 managers who supervised people who work outdoors reported on workplace and employee sun safety practices in a baseline survey.

Analysis showed that 20 of the state DOTs had a policy with at least one sun protection component (e.g., sunscreen, eye protection, use of shade). Sun safety training was increased at workplaces with written sun safety policy and unwritten standard operating procedures on sun protection. Sun safety actions were highest where there was a written sun safety policy and unwritten standard operating procedures on workplace sun protection. The measures, methods, analyses, results, conclusions, and limitations of the baseline manager survey are detailed in the publication.

This research was funded by a grant from the National Cancer Institute at the National Institutes of Health (CA210259; Dr. David Buller, Principal Investigator). Coauthors include Dr. Barbara Walkosz, Savanna Olivas, Rachel Eye, Xia Liu, Alishia Kinsey, Mary Buller, and Andrew Grayson from Klein Buendel.

KLEIN BUENDEL’S 2020 RESEARCH HIGHLIGHTS

KLEIN BUENDEL’S 2020 RESEARCH HIGHLIGHTS

In the year of COVID-19, Klein Buendel scientists and staff continued to conduct rigorous behavioral science research with numerous collaborators from across the country – sometimes under modified conditions. Our investigators launched 5 new projects, published (or e-published ahead of print) 15 research manuscripts in peer-reviewed journals, and presented their research findings at 5 national and international conferences (many of them virtual this year).

In the spring, Dr. Valerie Myers, KB Senior Scientist, was appointed as the Education, Training, and Career Development Council Chair on the Society of Behavioral Medicine (SBM) Board of Directors. SBM is a non-profit organization that brings together multiple independent disciplines to provide new perspectives and progress on human behavior, health, and illness. 

In November, Dr. David Buller, KB’s Director of Research, gave a Grand Rounds presentation at the Rutgers Cancer Institute of New Jersey, entitled “Cancer Prevention Policy: Promoting Adoption and Implementation of Sun Safety Policy.” And in December, Dr. Buller presented during a webinar hosted by the National Cancer Institute Division of Cancer Control and Population Sciences. The webinar was part of a series designed to explore Policy Implementation Science highlighting the importance of adoption of evidence-based policy in governmental and non-governmental sectors. 

KB was recognized in 2020 as #50 on Colorado Biz Magazine’s Top 100 Woman-Owned Companies list, and as #115 on their Top 200 Private Companies list.

And WayToServe, KB’s evidence-based online responsible alcohol server training program, sold its 100,000th training.

Publications

(KB investigators and staff are indicated in bold type)

  • Kitt-Lewis E, Loeb SJ, Myers V, Jerrod T, Wion RK, Murphy JL. Barriers to and Strategies for Gaining Entry to Correctional Settings for Health Research. Nurs Leadersh (Tor Ont). 2020 Mar;33(1):71-80. doi: 10.12927/cjnl.2020.26190.
  • Reynolds KD, Buller DB, Berteletti J, Massie K, Ashley J, Buller MK, Meenan RT, Liu X. School-level factors associated with sun protection practices in California elementary schools. J Sch Health. 2020 May;90(5):386-394.
  • Buller DB, Pagoto S, Baker K, Walkosz B, Hillhouse JJ, Berteletti J, Bibeau JL, Henry K. Knowledge and support for indoor tanning laws among mothers and teen daughters in 34 states in a randomized trial. Ann Behav Med. 2020 May;54(Suppl 1): S59.
  • Myers VH, Loeb SJ, Kitt-Lewis E, Murphy JL, Wion R, Jerod T. An e-training package to enhance care of aged and dying prisoners. Ann Behav Med. 2020 May;54(Suppl 1): S178.
  • Arroyo KM, Goetz J, Waring ME, Berteletti J, Buller DB, Walkosz B, Baker K, Hillhouse JJ, Henry K, Stapleton J, Pagoto S. Frequency and type of health misinformation in participant comments in a Facebook-delivered cancer risk reduction intervention. Ann Behav Med. 2020 May;54(Suppl 1): S186.
  • Buller DB, Woodall G, Saltz RF, Grayson AM, Buller MK, Svendsen SN, Liu L, Cutter GR. Effects of an online responsible vendor training for recreational marijuana stores on sales to pseudo-underage customers. Ann Behav Med. 2020 May;54(Suppl 1): S492
  • Gonzalez CD, Walkosz BJ, Dellavalle RP. Aftercare instructions in the tattoo community: An opportunity to educate on sun protection and increase skin cancer awareness. J Clin Aesthet Dermatol. 2020 Jun;13(6):22-23.
  • Buller DB, Reynolds KD, Buller MK, Massie K, Berteletti J, Ashley J, Meenan R. Parent reports of sun safety communication and behaviour for students in a randomized trial on a school policy implementation intervention. Aus N Z J Public Health. 2020;44(3):208-214.
  • Kaphingst KA, Khan E, White KM, Sussman A, Guest D, Schofield E, Dailey YT, Robers E, Schwartz MR, Li Y, Buller D, Hunley K, Berwick M, Hay JL. Effects of health literacy skills, educational attainment, and level of melanoma risk on responses to personalized genomic testing. Patient Educ Couns. 2020 Aug 1:S0738-3991(20)30392-X. doi: 10.1016/j.pec.2020.07.019.
  • Reynolds KD, Buller DB, Buller MK, Massie K, Berteletti J, Ashley J, Meenan R. Randomized controlled trial evaluating an intervention supporting implementation of sun safety policies in California public elementary schools. Prev Med. 2020 Aug;137:106125. doi: 10.1016/j.ypmed.2020.106125.
  • Buller DB, Woodall WG, Saltz R, Grayson A, Svendsen S, Cutter GR. Sales to apparently alcohol-intoxicated customers and online responsible vendor training in recreational cannabis stores in a randomized trial. Int J Drug Policy. 2020 Sep;83:102860. doi:10.1016/j.drugpo.102860.
  • Manne S, Buller D, Devine K, Heckman C, Pagoto S, Frederick S, Mitarotondo A. Sun Safe Partners Online: pilot randomized controlled clinical trial. J Med Internet Res. 2020 Sep;22(9):e18037. doi: 10.2196/18037.
  • Buller DB, Buller MK, Meenan R, Cutter GR, Berteletti J, Eye R, Walkosz BJ, Pagoto S. Design and baseline data of a randomized trial comparing two methods for scaling-up an occupational sun protection intervention. Contemp Clin Trials. 2020 Sep 14:106147. doi: 10.1016/j.cct.2020.106147.
  • Walkosz BJ, Dellavalle RP. Scented lotions may cause scaring and premature fading of tattoos. Dermatol Online J. 2020 Oct;26(10): 13030/qt5d2676s2.
  • Meenan RT, Reynolds KD, Buller DB, Massie K, Berteletti J, Buller MK, Ashley J, Liu X. Economic evaluation of a sun protection program in California elementary schools. Am J Health Promot. 2020 Nov;34(8):848-856. doi: 10.1177/0890117120905217.

Conference Presentations

Research by KB scientists, staff, and collaborators was presented at the following conferences this year:

  • Society of Research on Adolescence Biennial Meeting (March 2020)
  • Eastern Nursing Research Society (March 2020)
  • International Papillomavirus Conference & Basic Science, Clinical and Public Health Workshops (July 2020)
  • American Public Health Association (October 2020)
  • Annual Conference on the Science of Dissemination and Implementation in Health (December 2020)
Written Policy Predicts Worksite Sun Safety Training and Actions in State Departments of Transportation

Written Policy Predicts Worksite Sun Safety Training and Actions in State Departments of Transportation

Dr. David Buller, Klein Buendel Director of Research, presented a poster on workplace sun safety policies at the virtual 13th Annual Conference on the Science of Dissemination and Implementation in Health December 15-17, 2020.  

The U.S. Surgeon General and Community Guide recommend implementation of interventions to protect outdoor workers from solar ultraviolet radiation (UV) exposure to prevent skin cancer. For the research presented in this poster, written policies at state Departments of Transportation (DOTs) were examined and analyses tested the hypothesis that presence and strength of sun safety policy would be associated with greater implementation of workplace sun safety actions. 

Written policies from 21 U.S. state DOTs were coded for 15 sun safety components including engineering controls (physical work environment), administrative controls (workplace procedures), and personal protection practices (workers’ sun safety). Managers supervising outdoor workers in 138 regional DOT districts reported on workplace sun safety training and actions (monitoring UV Index to adjust work schedules, employees wearing UV-protective clothing, hats, eyewear, and sunscreen, sun safety messages to employees, employer provides sun protection resources and temporary/permanent shade, employer requests contractor staff comply with policy, employer encourages employees to regularly check skin, and employer conducts a risk assessment). 

Twenty state DOTs had a policy with at least one sun protection component (e.g., sunscreen, clothing, hat, shade provision, adjusting schedules), but almost none included training of employees, managers or supervisors. Many policies were also not explicitly intended for sun safety, except for sunscreen. Though not written, some reported unwritten standard operating, administrative, or training procedures on sun protection. Sun safety training and actions were predicted by a written sun safety policy and unwritten procedure, managers’ behaviors, job responsibilities, and characteristics. 

Policies are essential for implementation and maintenance of employee sun safety. While many state DOTs have policies, they could be improved by explicitly referencing sun safety. Also, training should be added to policy to create collective commitment among managers to support policy implementation and improve employees’ sun safety skills on the job. 

This research is funded by a grant from the National Cancer Institute (CA134705; Dr. David Buller, Principal Investigator). Additional poster coauthors included Dr. Barbara Walkosz, Mary Buller, Rachel Eye, Andrew Grayson, Alishia Kinsey, Xia Liu, and Savanna Olivas from Klein Buendel. 

Listen to the poster presentation.

Scented Lotions and Adverse Tattoo Reactions

Scented Lotions and Adverse Tattoo Reactions

Klein Buendel Senior Scientist, Dr. Barbara Walkosz, is a co-author on a recent publication in the Dermatology Online Journal. In the manuscript, Dr. Walkosz and her co-authors discuss how scented lotions may cause scaring, premature aging, and fading of tattoos.

Tattoo aftercare instructions are often provided to clients after receiving a tattoo. However, aftercare instructions can vary by studio and are often not universal or supported by research. The authors examine a case study of a man with no pre-existing skin conditions, family history, allergies, or other factors, who developed a rash on his new tattoo. Upon questioning, it was discovered that the client had applied a scented lotion to the new tattoo, at which point he began to experience problems with scabbing and fading tattoo ink.

The authors provide a case discussion about how the use of a scented lotion may have caused a negative, adverse reaction to the new tattoo and discuss the importance of treating a new tattoo as flesh wound. The full discussion and conclusion can be found in the publication.

This research team was funded by a grant and supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Authors also include, Dr. Adrian Pona from the Department of Dermatology at University of Colorado School of Medicine and the Department of Internal Medicine at the Vidant Medical Center of East Carolina University; Dr. Cristian Gonzalez from the Department of Dermatology at University of Colorado School of Medicine; and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the U.S. Department of Veterans Affairs Rocky Mountain Regional VA Medical Center Dermatology Service. 

Way to Serve Sells 100,000 Trainings

Way to Serve Sells 100,000 Trainings

WayToServe®, an evidence-based online responsible alcohol server training program, has sold its 100,000th training!

WayToServe was created by scientists and developers from the University of New Mexico, the Pacific Institute for Research and Evaluation, and Klein Buendel. The engaging, media-rich program was initially evaluated in a controlled randomized trial that resulted in high trainee satisfaction and increased refusal of sales to intoxicated patrons. WayToServe was licensed to Wedge Communications, LLC and launched into the online marketplace in 2012. To date, WayToServe has been tailored and approved for sale and certification of trainers in California, Texas, Washington, and New Mexico.

To meet the needs of Spanish-speakers, Klein Buendel is currently testing a companion program, WayToServe Español. “WayToServe Español es muy importante! It could help saves lives,” said Dr. W. Gill Woodall, the project’s director. The unique Spanish-language training program will be on the market in 2021.

The original WayToServe program was funded by two grants from National Institute on Alcohol Abuse and Alcoholism to the University of New Mexico (AA014982 and AA016606; Dr. W. Gill Woodall, Principal Investigator). The WayToServe Español program is funded by a grant from the National Institute of Minority Health and Health Disparities (MD010405; Dr. W. Gill Woodall, KB Senior Scientist, Principal Investigator).

Family Determinants of Sun-Safe Behaviors in Hispanic Children

Family Determinants of Sun-Safe Behaviors in Hispanic Children

Melanoma is common, particularly among Non-Hispanic Whites (NHW). However, Hispanics are diagnosed at more advanced stages compared to NHW prompting the need for more research into Hispanic sun protection practices.  

Sarah Davila, Klein Buendel collaborator and student from Claremont Graduate University, recently presented findings on family determinants of child sun protection from the Sun Safe Schools project at the virtual 2020 American Public Health Association conference. Family determinants of child sun protection have seldom been tested among Hispanics. The team hypothesized that parent sun protection behavior, perceived risk for skin cancer, skin-phenotype, and purchase of sun protection products, along with child skin-phenotype and interaction of child skin-phenotype with child ethnicity would associate with child sun protection behavior and child sunburn. To test this, parents of elementary school-aged children completed self-report surveys and a multilevel analysis was conducted with Hispanic and NHW parents nested within schools and nested within districts.  

Parent sun protection behavior, number of sun-safe items purchased, and child skin-phenotype were all positively associated with child sun protection behavior, while parent perceived risk was negatively associated. The interaction of child skin-phenotype with child ethnicity was significant, indicating no difference at Type 1 skin-phenotype, but greater protective behavior for Hispanics relative to NHW for subsequent skin-phenotypes. Parent perceived risk and child skin-phenotype were also positively associated with child sunburn. Overall, the results suggest a need for parent modeling and environmental controls to increase sun protection behavior in Hispanic children.  

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds and Dr. David Buller, Multiple Principal Investigators). Other authors included Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Kim Massie previously from Claremont Graduate University; and Julia Berteletti, Mary Buller, and Lucia Liu from Klein Buendel. 

Spotlight:
Dr. Christie Rizzo

Spotlight:
Dr. Christie Rizzo

Christie J. Rizzo, Ph.D., is an Associate Professor of Applied Psychology at Northeastern University, and maintains an appointment as an Adjunct Associate Professor of Psychiatry and Human Behavior at Brown University. Dr. Rizzo is leading a collaboration with Klein Buendel to create a Spanish version of Project STRONG, a web-based dating violence prevention program for parents and middle school boys. The interactive, technolyg-delivered curriculum is grounded in Developmental Assets Theory which asserts that family support, knowledge, values development, and social skills are necessary for healthy development and offset the emergence of risky behavior. Project Strong is funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD097126; Dr. Christie Rizzo, Principal Investigator).

Dr. Rizzo received her Ph.D. in Clinical Psychology from the University of Southern California. Much of her research focuses on the development and implementation of evidence-based, violence and risk behavior prevention programming for youth, including technology-based initiatives. She particularly focuses on vulnerable youth, such as those involved in the child welfare and juvenile justice systems. Dr. Rizzo was previously the Assistant Director of the Juvenile Mental Health Clinic at the Rhode Island Family Court. She now directs the Adolescent Relationships and Risk Behavior Lab at Northeastern University.

Along with Project STRONG, Dr. Rizzo’s current research projects include: 1) Dating Violence Prevention for Juvenile Justice Girls, and 2) Dating Violence Perpetration among Juvenile Justice Youth: The Role of Social, Behavioral, and Ecological Processes.

Health Literacy and Genomic Testing for Melanoma

Health Literacy and Genomic Testing for Melanoma

Dr. David Buller, Klein Buendel’s Director of Research, is a co-author on a paper published recently in Patient Education and Counseling that examines how health literacy skills impact primary care patients’ understanding of melanoma genetic testing results. The paper’s lead author is Dr. Kimberly Kaphingst from the Huntsman Cancer Institute and the Department of Communication at the University of Utah. Additional co-authors are from the Memorial Sloan Kettering Cancer Center in New York, and the Department of Internal Medicine at the University of New Mexico.

Making a significant health decision can be burdensome. It involves obtaining, processing, and weighing an abundance of new information. Personal health literacy skills may help lighten the load. According to the U.S. Department of Health and Human Services, “personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”

The Patient Education and Counseling paper describes the methods and measures used to examine whether health literacy skills, educational attainment, or melanoma risk were related to patients’ short-term cognitive and affective responses to personal melanoma genetic test results. Cognitive responses that were measured included perceived clarity and believability of the test results, and how often respondents thought about the test results. Affective reactions that were assessed included things like confusion, fear, hopefulness, relief, and regret, among others. Study results, conclusions, limitations, and implications are reported in the publication. Overall, the authors report that some individuals may need assistance in understanding genetic information related to melanoma risk.

This research was supported by the National Cancer Institute (CA181241; Dr. Jennifer Hay and Dr. Marianne Berwick, Multiple Principal Investigators) and the Huntsman Cancer Foundation.

Tattoo Aftercare Instructions and Sun Protection

Tattoo Aftercare Instructions and Sun Protection

Skin cancer rates continue to rise in the United States, so health researchers continue to explore novel ways to reach people with potentially life-saving information. In a recent commentary published in the Journal of Clinical and Aesthetic Dermatology, Klein Buendel Senior Scientist, Dr. Barbara Walkosz, and co-authors discuss how tattoo studios and their aftercare instructions provide a unique opportunity to reach younger adults with skin cancer prevention recommendations.

Sun protection for new tattoos, to some degree, is provided to most clients as part of the tattoo aftercare process. However, most aftercare instructions focus on the protection of the client’s tattooed skin, not comprehensive full-body sun protection. Most artists are not prepared to impart thorough sun safety recommendations, “such as applying sunscreen prior to sun exposure with a sun protection factor (SPF) of 30 or higher, reapplying sunscreen when outdoors for more than two hours, using clothing that physically blocks ultraviolet rays, wearing wide-brimmed hats that shade the head, or seeking shade when available.”

However, research suggests that tattoo artists are interested in learning about sun safety measures and open to sharing the information with their clients. In the commentary, the authors pinpoint the unique opportunity tattoo studios provide to reach younger adults with public health information, including through studio websites and social media pages. The commentary also shares results from in-depth interviews with tattoo artists and describes how tattoo aftercare instructions vary from state to state.

This research team was funded by a grant and supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Authors include Dr. Cristian Gonzalez from the Department of Dermatology at University of Colorado School of Medicine, Dr. Barbara Walkosz from Klein Buendel, and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the U.S. Department of Veterans Affairs Rocky Mountain Regional VA Medical Center Dermatology Service.  

Scaling-up an Evidence-based Workplace Sun Safety Program

Scaling-up an Evidence-based Workplace Sun Safety Program

Authors of a recent online publication in Contemporary Clinical Trails recommend that “successful methods for scaling-up evidence-based programs are needed to prevent skin cancer among adults who work outdoors in the sun.” The paper describes the design and baseline descriptive data from a workplace intervention being conducted by Klein Buendel and several research collaborators. The on-going randomized trial compares two methods of scaling-up the Sun Safe Workplaces intervention with 21 state Departments of Transportation and their employees who work outdoors. 

A total of 138 regional districts from the Departments of Transportation were randomly assigned to either an in-person program where project staff meet personally with managers, conduct trainings for employees, and provide printed materials, or a digital program where project staff conduct these same activities virtually, using conferencing technology, online training, and electronic materials.

Delivery of Sun Safe Workplaces in both groups is tailored to managers’ readiness to adopt occupational sun safety. Posttesting will assess manager’s support for and use of Sun Safe Workplaces and employees’ sun safety. An economic evaluation will explore whether the method that uses digital technology that may result in lower implementation of Sun Safe Workplaces, is more cost-effective relative to the in-person method.

The 21 state Departments of Transportation vary in size from 997 to 18,415 employees. At baseline, managers reported being generally supportive of occupational sun safety. A minority reported that the Departments had a written sun safety policy, half reported sun safety training for employees, and two-thirds reported messaging and communication about sun protection for employees. The research will help determine whether digital methods can facilitate a cost-effective scale-up of Sun Safe Workplaces for outdoor workers in industries across the country.  

This research project (CA210259) is funded as part of the National Cancer Institute’s Cancer Moonshot Initiative, which aims to accelerate cancer research in order to make more therapies available to patients, while also improving the ability to prevent cancer and detect it at an early stage. This project, Sun Safe Workplaces-Technology, is being led by KB’s Director of Research, Dr. David Buller, as Principal Investigator. Co-authors on the Contemporary Clinical Trails publication include Dr. Richard Meenan from Kaiser Permanente’s Center for Health Research, Dr. Gary Cutter from Pythagoras, Inc., Dr. Sherry Pagoto from the University of Connecticut, and Ms. Mary Buller, Ms. Julia Berteletti, Ms. Rachel Eye, and Dr. Barbara Walkosz from Klein Buendel.