STAC Parent Module Pilot Study

STAC Parent Module Pilot Study

Klein Buendel collaborator, Dr. Aida Midgett from Boise State University, presented formative research findings from her CTR-IN Pilot Grant at the Mountain West CTR-IN Annual Meeting in Las Vegas, Nevada, November 17-18, 2022. Mountain West CTR-IN connects research investigators to mentors, collaborators, and funding opportunities to improve the health and lives of people in mountain west communities, including through research projects funded by the National Institutes of Health. Ms. Mary Buller, President of Klein Buendel, is Dr. Aida’s mentor for the CTR-IN Pilot Grant.

Dr. Midgett presented on the “Development, Acceptability, and Short-Term Outcomes of a Parent Module for Brief, Bullying Bystander Intervention for Middle School Students in Rural, Low-Income Communities.” Her co-author was Dr. Diana Doumas from Boise State University. The project statistician was Ms. Laura Bond from Boise State University. The pilot study used a mixed-methods design to develop a 30-minute pre-recorded Parent Module as a companion training to a brief bullying prevention program for middle schools, called STAC. The study assessed the need, feasibility, acceptability, delivery format preference and immediate outcomes (e.g., knowledge, attitudes, self-efficacy, and behavioral intentions) of the Parent Module.

As background, the STAC bystander intervention is a 75-minute training that includes didactic and experiential components. It teaches middle school students to act as “defenders” on behalf of targets of bullying through utilizing four intervention strategies: (1) “Stealing the Show” – using humor or distraction to interrupt a bullying situation and remove the attention away from the target; (2) “Turning it Over” – identifying a trusted adult at school, reporting, and asking for help during a bullying incident; (3) “Accompanying Others” – befriending and/or providing support to a peer who was a target of bullying; and (4) “Coaching Compassion” – gently confronting the perpetrator and increasing empathy for the target.

Dr. Midgett reported that preliminary data with 23 parents in the pilot study demonstrated acceptability, relevance, and need and increases in immediate post-training outcomes including knowledge, confidence, self-efficacy, responsibility, and anti-bullying attitudes, as well as parents’ behavioral intentions to support their adolescents to utilize the STAC strategies.

Another aim of Dr. Midgett’s CTR-IN pilot grant is to provide data to support a STTR Fast Track proposal to develop and evaluate a web-based version of the Parent Module as a STAC companion training. The proposal will be submitted through Klein Buendel and the research plan will include a multi-site randomized trial in rural schools. Klein Buendel’s Creative Team will program the web-based Parent Module.

iTRAC Pilot Study

iTRAC Pilot Study

A research team led by Dr. Christopher Houck from Lifespan and the Rhode Island Hospital has published a paper in the Journal of Developmental & Behavioral Pediatrics on the feasibility and acceptability of an initial digital iTRAC (Talking About Risk and Adolescent Choices) intervention. Collaborators included colleagues from the Rhode Island Hospital, the University of Oregon, Brown University, Penn State University, and Klein Buendel. iTRAC is a tablet-based intervention to promote emotion regulation skills among middle schoolers as a strategy for reducing risky behavior.

For the pilot study, adolescents aged 12–14 years were recruited from three urban schools for advisory groups (n=15), acceptability testing (n=11), and pilot testing (n=85). Youth advisory boards and expert panels tailored content, resulting in an animated intervention of instructional videos, games, and activities designed to teach emotion regulation strategies to young adolescents. Eighty-five adolescents were randomized to the 4-module digital iTRAC intervention or a wait-list control group. Adolescents and one parent completed baseline and 3-month follow-up questionnaires examining emotion regulation attitudes and behaviors. The adolescent participants also completed behavioral tasks related to distress tolerance.

Eighty-eight percent of those randomized to iTRAC completed all modules. Moderate effect sizes were found from baseline to follow-up on adolescents’ beliefs in the controllability of emotions, awareness of emotions, self-efficacy for managing emotions, perceived access to emotion regulation strategies, and use of emotion regulation strategies. Parent measures of adolescent regulation showed mixed results.

A tablet-based intervention to enhance emotion skills for youth in early adolescence was deemed feasible and demonstrated promising indicators of impact on emotional competence. Increasing adolescents’ awareness of and access to emotion regulation strategies may reduce decisions driven by transient emotions, which in turn may reduce engagement in risky behavior and resultant negative health outcomes. The authors conclude that the brief iTRAC intervention may be used to increase emotional competency among middle schoolers.

Dr. Valerie Myers and Ms. Tiffany Jerrod, both formerly from Klein Buendel, were co-authors on this publication. Research on the full production and evaluation of iTRAC is continuing with an STTR Fast Track grant to Klein Buendel from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Dr. Christopher Houck, Principal Investigator from Lifespan; HD110333). Collaborators on the current study include Dr. Wendy Hadley from the University of Oregon; Dr. David Barker from Rhode Island Hospital; and Ms. Julia Berteletti from Klein Buendel. The iTRAC modules will be programmed by Klein Buendel’s Creative Team.  

Welcome Dr. Kayla Nuss!

Welcome Dr. Kayla Nuss!

Kayla Nuss, Ph.D., is Klein Buendel’s newest Scientist and Principal Investigator. Dr. Nuss comes to Klein Buendel from a post-doctoral fellowship with the Digital Health Lab at the University of Victoria in Canada, where she analyzed de-identified data for a comprehensive digital diabetes intervention program in India. 

In 2021, Dr. Nuss earned her Ph.D. in Bioenergetics from Colorado State University (CSU). Her dissertation was titled “Wearable Fitness Trackers in Physical Activity Research: Accuracy and Effects on Motivation and Engagement.” She also has two Master’s Degrees: one in Health and Exercise Science from CSU and a second in Student Development in Post-Secondary Education from the University of Iowa. She has a Bachelor’s Degree in Psychology and Spanish from Cornell College in Iowa. And she graduated from our local Golden High School!

Dr. Nuss’ research interests center on motivation for physical activity, how wearable technology supports or thwarts motivation in various populations, and how to optimize wearable technology to support the development and maintenance of engagement in physical activity.

At Klein Buendel, she is currently collaborating with Dr. Robert Newton from the Pennington Biomedical Research Center in Louisiana, Dr. Derek Griffith from Georgetown University, and Dr. David Buller from Klein Buendel on a research study to address physical activity maintenance in African American men with smartphone technology (MD014947; Dr. Robert Newton and Dr. Kayla Nuss, Multiple Principal Investigators).

Dr. Nuss is also a Co-Investigator on a collaborative team of highly-experienced cancer prevention and control investigators from the Four Corners Cancer Centers Collaborative (University of Arizona, University of Colorado, University of New Mexico, and University of Utah), Colorado State University, and Klein Buendel (CA268037; Dr. David Buller and Dr. Andrew Sussman from the University of New Mexico, Multiple Principal Investigators). This team is launching a 5-year research study focusing on decreasing cancer risk factors among emerging adults (ages 18-26) living in rural counties in the “Four Corners” states (Arizona, Colorado, New Mexico, and Utah) using a social media campaign. Dr. Nuss will lend her expertise in the area of motivation for physical activity.

iTRAC Fast Track Project

iTRAC Fast Track Project

A collaborative research team from the University of Oregon, Rhode Island Hospital and its parent organization Lifespan Health Systems, and Klein Buendel has launched a new research project to develop and evaluate the impact of an emotion regulation program for adolescents. iTRAC will be a web-based program for “Talking about Risk and Adolescent Choices” to prevent risky sexual behavior and negative sexual health outcomes through emotion regulation strategies. The original TRAC program was developed and evaluated in multiple previous studies (MH078750, NR011906, and HD089979) by Dr. Christopher Houck from Lifespan and his team. 

In the new study, the original TRAC will be enhanced for emotion regulation, programmed as a web-based app (iTRAC) and assessed for acceptability by adolescents ages 12 to 14. The investigators will then conduct a randomized controlled trial examining the efficacy of the completed iTRAC intervention relative to a waitlist control among 120 adolescents. The study will examine the efficacy of iTRAC relative to a waitlist control in enhancing theoretically important emotional competencies, such as emotion regulation, emotion recognition, and distress tolerance that mediate risk as measured by self-report, performance measures, and parent report. 

The investigators hypothesize that: (1) iTRAC will receive positive adolescent ratings during acceptability testing for ease of use, enjoyment, and usefulness of content; (2) participants in iTRAC will report greater self-efficacy for sexual risk prevention skills over 6-month follow-up than comparison participants; and (3) youth in iTRAC will exhibit improved emotional competencies relative to the comparison group. 

The iTRAC project is funded by an STTR Fast Track grant to Klein Buendel from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Dr. Christopher Houck, Principal Investigator from Lifespan; HD110333). Collaborators include Dr. Wendy Hadley from the University of Oregon; Dr. David Barker from Rhode Island Hospital; and Ms. Julia Berteletti from Klein Buendel. The iTRAC modules will be programmed by Klein Buendel’s Creative Team.  

Collaborator Spotlight:
Dr. Alexandra Morshed

Collaborator Spotlight:
Dr. Alexandra Morshed

Alexandra Morshed, Ph.D., is a Research Assistant Professor in the Department of Behavioral, Social and Health Education Services at Emory University. She is also a Co-Investigator with the Emory Prevention Research Center. Dr. Morshed received her Master of Science degree from Wageningen University in the Netherlands and her Ph.D. from Washington University in St. Louis.

Dr. Alexandra Morshed

Dr. Morshed is an implementation scientist with more than ten years of experience in public health research and practice. Her primary areas of interest include implementing interventions in vulnerable populations, chronic disease prevention, public health nutrition, and capacity building and knowledge expansion in dissemination and implementation science.

Dr. Morshed is currently collaborating with Dr. David Buller from Klein Buendel on a research study titled “Go Sun Smart at Work: A Sun Safety Program for Underserved Outdoor Workers” (Dr. Morshed and Dr. Buller, Multiple Principal Investigators). This CDC-funded study builds upon Klein Buendel’s evidence-based comprehensive occupational skin cancer prevention intervention, Go Sun Smart at Work, and aims to reduce UV exposure and prevent skin cancer among underserved outdoor workers in Georgia. Hispanic and African American adults have been overlooked in skin cancer prevention efforts, due to their lower incidence of skin cancer. However, among Hispanic and African Americans, skin cancer is diagnosed at more advanced stages, leading to higher mortality rates than non-Hispanic whites. The Emory University study aims to develop an intervention and implementation strategies to increase policies and practices to support sun safety among outdoor workers in Georgia.

UV Measured under Built Shade in Public Parks

UV Measured under Built Shade in Public Parks

Reducing exposure to ultraviolet radiation (UV) is crucial for preventing UV-induced diseases of the skin and eyes. Shade may offer significant protection from UV.

A research team from Klein Buendel and Cancer Council Victoria and LaTrobe University in Australia have published a paper on UV measurements under shade structure built in public parks in International Journal of Environmental Research and Public Health. The paper expands empirical research to quantify the UV protection offered from built shade to guide disease prevention practices and confidence in investment in shade.

Specifically, the research team quantified UV levels under built shade relative to unshaded passive recreation areas (PRAs) over summer months in parks in two cities (Denver, Colorado, USA and Melbourne, Victoria, Australia). In a randomized controlled trial, 1,144 UV measurements were recorded at the center and periphery of PRAs in a total sample of 144 public parks as part of pretest and posttest measures of use of the PRAs by park visitors. UV measurements were recorded for three recruitment waves per city during 2010 to 2014. Following pretest, 36 of the PRAs received built shade structures.

Regression analyses modelled pre-post change in UV (Standard Erythemal Dose (SED) per 30 min) at PRAs; and environmental predictors. Mean UV at the center of built shade PRAs decreased from pretest to posttest, adjusting for the covariates of ambient SED, solar elevation, and cloud cover. Clouds decreased and solar elevation increased UV levels under shade. No significant differences in UV by design of the shade structure occurred. A substantial reduction in UV exposure can be achieved using built shade with shade cloth designs, offering considerable protection for shade users. Supplementary sun protection  is recommended for extended periods of shade use during clear sky days. This could include things like brimmed hats, long sleeves, sunglasses, and sunscreen.

This research was supported by a grant from the National Cancer Institute (CA140367; Dr. David Buller, PI). Collaborators on this publication also include Dr. Suzanne Dobbinson and Dr. James Chamberlain from Cancer Council Victoria; Jody Simmons from LaTrobe University; and Mary Buller from Klein Buendel.

#4Corners4Health

#4Corners4Health

A collaborative team of highly-experienced cancer prevention and control investigators from the Four Corners Cancer Centers Collaborative (University of Arizona, University of Colorado, University of New Mexico, and University of Utah), Colorado State University, and Klein Buendel is launching a research study that focuses on decreasing cancer risk factors among emerging adults (ages 18-26) living in rural counties in the “Four Corners” states (Arizona, Colorado, New Mexico, and Utah) using a social media campaign. Cancer risks related to infrequent physical activity, unhealthy diet, nicotine product use, alcohol intake, ultraviolet radiation exposure and lack of HPV vaccination are prevalent among emerging adults and contribute to cancer later in life.

The project will test a theory-based, multi-risk factor social media approach to cancer prevention through the use of Facebook and its private group function. Social media can improve information dissemination, credibility, and relevance, be used to detect and respond to emerging trends, and engage users with user-generated content that personalizes information. It offers a superior intervention for emerging adults compared to health care, schools, and workplaces which can be challenging to implement in low-resourced rural communities and will not reach many emerging adults who have low preventive health care utilization, school enrollment, and/or employment.


#4Corners4Health Specific Aims

  • Develop a social media intervention for diverse emerging adults in rural communities via a community-engaged process that combines expert advice, user-generated content, and online instruction about behavioral cancer risks, cancer misinformation, counter marketing, digital and media literacy, and family communication.
  • Evaluate the effect of a theory-based social media intervention on moderate to vigorous physical activity (MVPA), health eating patterns, nicotine product use, alcohol intake, sunburn prevalence, and HPV vaccination with the diverse (ethnically/ socioeconomically) population of emerging adults aged 18-26 in rural counties in the Four Corner states recruited from Qualtrics’ survey panel and enrolled in a pragmatic randomized trial using a stepped-wedge design in which individual emerging adults will be randomized to one of four cohorts and receive social media feed for varying durations in separate Facebook private groups.
  • Test if improvements in merging adults cancer risk knowledge and beliefs, digital and media literacy skills, accurate cancer prevention information, and family communication mediate impact of the social media campaign.
  • Explore whether the impact of the social media campaign differs according to a) level of emerging adults engagement with campaign, b) cancer risk factors, and c) biological sex of the participants.

The investigators hypothesize that (1) emerging adults will increase MVPA and healthy eating pattern, reduce nicotine product and alcohol use, and sunburns, and increase HPV vaccine uptake from pre to post when receiving social media campaign, and (2) positive impact of the social media campaign on cancer risk factors among emerging adults will be mediated by improved cancer risk knowledge and beliefs (self-response efficacy; norms; social support; vaccine antecedents), digital and media literacy skills, misinformation, and family communication.

This research will be led by Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico (Multiple Principal Investigators). It is being funded by a 5-year R01 grant from the National Cancer Institute (CA268037). Key collaborators include Dr. Kimberly Henry from Colorado State University; Dr. Cindy Blair from the University of New Mexico; Dr. Judith Gordon, Dr. Cynthia Thomson, and Dr. Jennifer Hatcher from the University of Arizona; Dr. Evelinn Borrayo and Dr. Douglas Taren from the University of Colorado; Dr. Deanna Kepka, Dr. Echo Warner, and Dr. David Wetter from the University of Utah; and Dr. Gill Woodall, Dr. Barbara Walkosz, Dr. Kayla Nuss, and Ms. Julia Berteletti from Klein Buendel.

Promoting Social Distancing and COVID-19 Vaccination in a Social Media Feed for Mothers

Promoting Social Distancing and COVID-19 Vaccination in a Social Media Feed for Mothers

The Health Chat team from Klein Buendel, the University of Connecticut, Colorado State University, and East Tennessee State University has published findings from a health communication study in the journal JMIR Infodemiology. The purpose of the study was to examine how the source of health information shared via a Facebook social media feed might impact behavioral intentions related to practicing social distancing or accepting COVID-19 vaccination. The Facebook group participants were mothers of adolescent daughters. The social media feed varied the source of information in posts on four topics: social distancing, COVID-19 vaccines, digital and media literacy, and family communication about COVID-19. The information sources were government agencies, near-peer parents, and news media.

In summary, 303 mothers with adolescent daughters from a previous study testing a social media campaign on indoor tanning were recruited in January 2021 and enrolled in a randomized single-factor design (government agencies vs. near-peer parents vs. news media) evaluating the 9-week Facebook feed with four assessments at baseline and 3-week, 6-week, and 9-week follow-ups. Mothers received one social media post each day (Monday-Friday) in three randomly assigned Facebook private groups, covering all four topics plus one additional post on a positive non-pandemic topic to promote engagement. Posts in the three groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Views, reactions, and comments related to each post were counted to measure engagement with the messages. Mothers reported on social distancing and vaccine intentions for themselves and their daughters at the four assessment points.

Research methods and analyses are detailed in the JMIR Infodemiology paper. Nearly all mothers (98%) remained in the Facebook private groups throughout the 9-week trial period, and assessment completion rates were high. Analysis showed that social distancing behavior by mothers and daughters decreased over time but vaccine intentions increased. Decrease in social distancing by daughters was greater in the near-peer source group and lesser in the government agency group. The higher perceived credibility of the assigned information source increased social distancing and vaccine intentions. Mothers’ intentions to vaccinate themselves may have increased when they considered the near-peer source to be not credible. According to the authors, decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652). Dr. David Buller from Klein Buendel and Dr. Sherry Pagoto from the University of Connecticut were the project’s Multiple Principal Investigators. Additional authors on this publication include Joseph Divito from the University of Connecticut; Dr. Kim Henry from Colorado State University; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; and Dr. Barbara Walkosz, Dr. Gill Woodall, Julia Berteletti, and Alishia Kinsey from Klein Buendel.

Effects of Engagement with a Social Media Campaign to Reduce Indoor Tanning

Effects of Engagement with a Social Media Campaign to Reduce Indoor Tanning

A paper by Klein Buendel scientists, staff, and collaborators published in the Journal of Health Communication reports on a secondary analysis of engagement effects from a social media campaign. The campaign, called Health Chat, was aimed at reducing mothers’ permissiveness for indoor tanning (IT) by their teenage daughters.

In the study, over 800 mothers with daughters aged 14-17 were recruited in 34 states that did not ban IT by minors under age 18 for a randomized trial. Follow-up assessments were completed at the end of the intervention (12 months) and six months after that (18 months). Daughters’ baseline and follow-up responses were analyzed also. Mothers received a Facebook feed on adolescent health topics that included posts about preventing IT (intervention) or prescription drug misuse (control).

Engagement was measured by extracting reactions (such as like or sad) and comments posted by mothers to the campaign posts. Overall, 76.4% of posts received a reaction and/or comment. Mothers who engaged with IT posts were less permissive of daughters’ IT immediately at the end of the campaign and six months after the intervention than mothers who did not engage with the posts.

Social media is a large part of the media diets of many parents and show some promise for health behavior change interventions. Social media posts need to both reach and engage parents, especially in social media like Facebook whose algorithm prioritizes posts from feeds that receive more views, reactions, and comments. This is to ensure that the posts appear in participants’ news feeds so well-crafted health communication can influence them. The authors conclude, however, that more work is needed on strategies to engage individuals with social media posts in the context of improving public policies that restrict minors’ access to IT facilities.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Kimberly Henry from Colorado State University; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Jessica Bibeau from the University of Connecticut; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.

Evaluation of the STAC
Teacher Module

Evaluation of the STAC
Teacher Module

Bullying is a significant problem for youth and is associated with a wide range of negative consequences. Educating teachers about bullying and training them to support students to intervene as “defenders” may increase the efficacy of bullying bystander programs. This is particularly important in middle school when bullying peaks and rates of reporting bullying to teachers begin to decline.

This study, published in JMIR Formative Research, used a mixed-methods design to inform the development of a Teacher Module as a companion training to a brief bullying prevention program for middle schools, called STAC. The STAC bystander intervention is a 75-minute training that includes didactic and experiential components. It teaches middle school students to act as “defenders” on behalf of targets of bullying through utilizing four intervention strategies:

STAC Bullying Bystander Strategies

(1) “Stealing the Show” – using humor or distraction to interrupt a bullying situation and remove the attention away from the target;

(2) “Turning it Over” – identifying a trusted adult at school, reporting, and asking for help during a bullying incident;

(3) “Accompanying Others” – befriending and/or providing support to a peer who was a target of bullying; and

(4) “Coaching Compassion” – gently confronting the perpetrator and increasing empathy for the target.

Providing students who witness bullying with intervention strategies to act as “defenders” can reduce both bullying and negative associated outcomes for both targets and bystanders.

For the development of the companion STAC Teacher Module, 18 teachers were recruited from one middle school in a rural, low-income community. Before and after the training, teachers completed surveys assessing immediate outcomes (such as knowledge, confidence, comfort, and self-efficacy), intention to use the program strategies, and program acceptability and relevance. After the final survey, a subset of six teachers participated in a qualitative focus group to obtain feedback regarding program appropriateness, feasibility, content, perception of need, and potential desire for an online version of the teacher training.

Study measures, procedures, analyses, and results are detailed in the JMIR Formative Research paper. Descriptive statistics, independent sample t-tests, and thematic analysis were used to analyze the data. In summary, the researchers found an increase in teacher knowledge and confidence to support “defenders,” confidence and comfort in managing bullying, and bullying self-efficacy. Most teachers reported they were likely or very likely to use the STAC strategies to support students who intervene in bullying in the future. Both quantitative and qualitative data showed the teacher training was easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on program improvement. Teachers shared positive feedback on program feasibility and implementation, and described strengths of an online version of the module. This study demonstrates the effectiveness of the STAC Teacher Module in increasing teacher knowledge and bullying self-efficacy and provides support for the development of an online version of the module for teachers.

This research was supported by a grant to Boise State University from the Mental Research Institute (Dr. Aida Midgett, Principal Investigator). Co-authors include Dr. Diana Doumas from Boise State University and Ms. Mary Buller from Klein Buendel.