Preventing Alcohol and Drug Overuse Among Nightclub Patrons

Preventing Alcohol and Drug Overuse Among Nightclub Patrons

Nightclubs are high-risk settings for overuse of alcohol and other drugs. In a July publication in the Journal of Studies on Alcohol and Drugs, collaborators from the Pacific Institute for Research and Evaluation (PIRE), the University of California San Francisco, and Klein Buendel reported the outcomes of their intervention to protect nightclub patrons from substance abuse and harmful consequences.

Nightlife Safety Plans (NSP) is a group-based, tablet app-delivered intervention designed for groups of patrons arriving at nightclubs together. NSP encourages social groups to recognize early indicators of risk and take actions steps to de-escalate risky situations, such as physical and sexual aggression, through peer influence and other methods. The intervention was designed around a simple mnemonic – the three O’s: Outreach, Options, and Out:

  • Outreach: “provide outreach by approaching the friend and checking in, using nonconfrontational approaches”
  • Options: “provide options to a group member if a problem is identified”
  • Out: “know when the group should get out of the club to avoid further problems”

A total of 959 people from 352 social groups participated in the intervention at 41 different electronic music dance events at nightclubs in San Francisco, California. The measures (including breath samples for blood alcohol concentration and oral fluid samples for drug use), methods, analyses, results, discussion, and limitations are detailed in the publication.

In summary, intervening in the right place at the right time with peer influence strategies proved to be effective. The authors report that the NSP app appeared to increase protective actions to keep group members safe from overuse of alcohol and other drugs in these high-risk environments.

This research was funded by a grant to the Prevention Research Center at PIRE from the National Institute on Alcohol Abuse and Alcoholism (AA022331; Dr. Brenda Miller, Principal Investigator). Authors of the publication include Dr. Hilary Byrnes, Dr. Brenda Miller, Dr. Mark Johnson, and Veronica Rogers from PIRE; Dr. Beth Bourdeau from the University of California San Francisco; and Dr. David Buller and Julia Berteletti from Klein Buendel. The NSP tablet app was developed by Klein Buendel’s Creative Team.

Ultraviolet Radiation and the Fading of Colored Tattoos

Ultraviolet Radiation and the Fading of Colored Tattoos

In a recent publication in Photodermatology, Photoimmunology and Photomedicine, authors from the University of Colorado School of Medicine and Klein Buendel examine a case and describe how ultraviolet radiation (UVR) may affect tattoos by causing abnormal healing, premature fading, scabbing, and scarring.

The case under review revolved around a male patient with Fitzpatrick skin type III who presented concerns about a colored tattoo that had visibly undergone premature fading. In addition to a physical exam, the patient’s outdoor habits, medical history, and sun safety behaviors were also documented. The patient had visible uneven distribution of red and yellow pigment in the tattoo on his arm. The full report, discussion, and conclusion can be found in the publication.

Although tattoo fading is a multifaceted process, excessive UVR exposure can be a preventable factor. By taking simple measures such as wearing sunscreen greater than SPF 30, wearing sun protective clothing, and seeking shade, individuals can minimize unnecessary sun exposure to protect their skin and tattoos.

This project was funded by a grant and a supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Paper authors include Dr. Cristian Gonzalez, Dr. Chandler Rundle, and Dr. Adrian Pona from the 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.

Melanoma Receptor Variation in a New Mexico Population

Melanoma Receptor Variation in a New Mexico Population

Dr. David Buller, KB Senior Scientist and Director of Research, is a co-author on a paper published recently in Cancer Epidemiology, Biomarkers & Prevention. The paper examines the Melanocortin 1 Receptor (MC1R) in a multicultural New Mexican population. MC1R is a risk factor for developing melanoma skin cancer because it contributes to skin pigmentation. The paper’s lead author is Dr. Kirsten White from the University of New Mexico. Other co-authors are from the Memorial Sloan Kettering Cancer Center in New York, the University of Utah, and the University of New Mexico.

Specifically, single-nucleotide polymorphisms (SNPs) in MC1R and their association with race and ethnicity, skin type, and perceived cancer risk were evaluated by genotyping MC1R in 191 primary care clinic patients in Albuquerque, New Mexico. A full description of the methods, results, conclusions, and limitations of the research can be found in the publication.

Overall, the authors concluded that a specific variant of interest in MC1R may not be a risk factor for melanoma among New Mexican Hispanics, and that genetic risk cannot be inferred from Northern European populations directly to non-European populations.

STAC-T: A Bystander Bullying Intervention for Middle Schools

STAC-T: A Bystander Bullying Intervention for Middle Schools

Nationally, 20.8% of students age 12-18 report being bullied at school and 11.5% report being cyberbullied (1). Bullying peaks in middle school with 26% of students reporting being a target of bullying (1). Among middle schoolers, bullying victimization is associated with a variety of mental health problems including anxiety, depression, and suicide attempts. In addition, negative consequences linked with bullying extend to students who observe bullying (2). Student bystanders are also at increased risk for mental health problems, such as helplessness, isolation, and guilt. With 8 out of 10 students witnessing bullying (2), students need to know how to appropriately intervene.

The goal of Klein Buendel’s new Phase I STTR project is to begin to develop and test the feasibility of a middle school intervention to reduce bullying and its negative consequences. The project is being led by Dr. Aida Midgett (Principal Investigator) and Dr. Diana Doumas (Co-Investigator) of Boise State University, and Dr. Valerie Myers (Co-Investigator) of Klein Buendel.  The project is entitled “Translation of an In-Person Brief, Bystander Bullying Intervention (STAC) into a Technology-Based Program”.

Research has shown that bystanders can stop bullying by intervening (3, 4). Yet, most students do not intervene to defend targets because they do not know what to do (5). Comprehensive, school-wide bullying programs can be effective (6), but time- and labor-intensive resources required for program implementation pose significant barriers for schools, particularly in low-income and rural communities, which can reduce program uptake. To reduce these barriers, Dr. Midgett developed a brief bullying bystander intervention, using four strategies: “Stealing the show,” “Turning it over,” “Accompanying others,” and “Coaching compassion” (STAC) (7). STAC has been shown to be effective in reducing bullying perpetration (8,9) and victimization (8) and negative mental health consequences for bystanders who witness bullying (10-15).

Although brief interventions reduce implementation barriers, in-person programs still require training and delivery by school personnel, placing significant demands on schools. The product developed in this Phase I project is a technology-based, brief bystander bullying intervention (STAC-T) that can impact current bullying prevention approaches by: (a) significantly reducing implementation barriers for middle schools, particularly those in low-income and rural communities that can face educational, social, and health disparities; (b) training bystanders to effectively intervene, reducing bullying while simultaneously improving the mental health of bystanders; and (c) improving the program sustainability potential at the middle school level when bullying behavior typically reaches its peak.

This research project is funded by a grant from the National Institute on Minority Health and Health Disparities at the National Institutes of Health (MD014943; Dr. Aida Midgett, Principal Investigator).


  1. National Center for Education Statistics. Student Reports of Bullying: Results from the 2015 School Crime Supplement to the National Crime Victimization Survey. U.S. Department of Education;2016. NCES 2017-015.
  2. Rivers I, Poteat VP, Noret N, Ashurst N. Observing bullying at school: the mental health implications of witness status. Sch Psychol Q. 2009;24(4):211-223.
  3. Salmivalli C, Voeten M, Poskiparta E. Bystanders matter: associations between reinforcing, defending, and the frequency of bullying behavior in classrooms. J Clin Child Adolesc Psychol. 2011;40(5):668-676.
  4. Padgett S, Notar CE. Bystanders are the key to stopping bullying. Universal Journal of Educational Research. 2013;1(2):33-41.
  5. Hutchinson M. Exploring the impact of bullying on young bystanders. Educational Psychology in Practice. 2012;28(4):425-442.
  6. Gaffney H, Ttofi MM, Farrington DP. Evaluating the effectiveness of school-bullying prevention programs: an updated meta-analytical review [published online ahead of print July 20]. Aggr Violent Behav. 2018 doi:
  7. Midgett A, Doumas D, Sears D, Lundquist A, Hausheer R. A bystander bullying psychoeducation program with middle school students: a preliminary report. Professional Counselor. 2015;5(4):486-500.
  8. Midgett A, Doumas DM, Johnston AD. Establishing school counselors as leaders in bullying curriculum delivery:Evaluation of a brief, school-wide bystander intervention. Professional School Counseling. 2017;21(1):1-9.
  9. Midgett A, Doumas DM, Trull R, Johnson J. Training students who occasionally bully to be peer advocates: is a bystander intervention effective in reducing bullying behavior? Journal of Child and Adolescent Counseling. 2017;3(1):1-13.
  10. Moran M, Midgett A, Doumas DM, Porchia S, Moody S. A mixed method evaluation of a culturally adapted, brief, bullying bystander intervention for middle school students. Under review
  11. Doumas DM, Midgett A, Watts AD. The impact of a brief, bullying bystander intervention on internalizing symptoms: Is gender a moderator of intervention effects? [published online ahead of print February 14]. Sch Psychol Int. 2019 doi: 10.1177/0143034319830149
  12. Watts A, Doumas DM, Midgett A. The efficacy of a brief, bystander bullying intervention on alcohol use among high school students. Journal of Addictions and Offender Counseling. In press
  13. Midgett A, Doumas DM. The impact of a brief, bullying bystander intervention on depressive symptoms. Journal of Counseling and Development. In press
  14. Midgett A, Doumas DM, Trull R. Evaluation of a bystander bullying intervention program for elementary school students. Professional School Counselor. 2018;20(1):172-183.
  15. Midgett A, Doumas DM, Trull R, Johnston A. A randomized controlled study evaluating a brief, bystander bullying intervention with junior high school students. Journal of School Counseling. 2017;15
Economic Evaluation of Adopting Occupational Sun Protection Policies

Economic Evaluation of Adopting Occupational Sun Protection Policies

In a recent publication in the Journal of Occupational and Environmental Medicine, Klein Buendel investigators and their colleagues discuss the economic evaluation of an intervention promoting adoption of occupational sun protection actions by Colorado public-sector employers.

The intervention, Sun Safe Workplaces (SSW), was a two-year randomized field trial promoting employer adoption of sun safety policy and providing training in personal sun protection for outdoor workers. The trial included 98 local Colorado government organizations such as municipalities, counties, and special districts (public organizations providing water, sanitation, parks and recreation, and fire protection). SSW intervention costs were organized into two components: “delivery” costs and “action” costs. Delivery costs were incurred to directly implement and maintain the SSW intervention and included costs of both project staff and the participating worksites. Action costs were incurred by the worksites themselves for implementing the sun protection actions.

The publication presents the results of the economic evaluation of SSW. A full description of the methods, measures, results, and conclusion of the research can also be found in the Journal of Occupational and Environmental Medicine publication.

This study demonstrated the interactions of cost and implementation that explain — and hopefully guide — the adoption of and investment in occupational sun safety. The SSW intervention was also successful in extending the adoption of sun protection actions among intervention worksites at a cost per employee that is comparable to other worksite health interventions.

This analysis was funded by a grant from the National Cancer Institute at the National Institutes of Health (CA134705; Dr. David Buller and Dr. Barbara Walkosz, Multiple Principal Investigators). The paper’s lead author is Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Oregon. Additional authors include Dr. David Buller, Dr. Barbara Walkosz, Ms. Mary Buller, Ms. Rachel Eye, and Ms. Savanna Olivas from Klein Buendel; and Dr. Allan Wallis from the University of Colorado Denver.

Collaborator Spotlight:
Dr. Michael Hecht

Collaborator Spotlight:
Dr. Michael Hecht

Michael L. Hecht, Ph.D., is the co-president of REAL Prevention LLC. He currently works with Klein Buendel Senior Scientist, Dr. David Buller, on a project entitled, “Feasibility of a Mobile Parent-Based Intervention to Reduce Alcohol Use by High School Seniors.” The Phase II SBIR research project is funded by the National Institute on Alcohol Abuse and Alcoholism (AA025293; Dr. Michael Hecht, Principal Investigator).

The program aims to provide an efficient, engaging and effective means to enhance parents’ ability to reduce prevalence of alcohol use and consequences, and other substance use. The program, called Parenting Now (PN), is adapted from the evidence-based Parent Handbook and includes a brief, interactive, self-paced, web-based curriculum for parents of non-college bound high-school-aged adolescents. KB will develop the PN program, which was previously tested in a Phase I trial, and it will include core and optional modules in order to target parents based on their communication style. Parents will be able to customize their experience by choosing or clicking through the optional content. Results will help prepare PN for dissemination through D.A.R.E. America’s new high school program as well as REAL Prevention’s other community-based partners, such as 4-H and Planned Parenthood.

In addition to substance abuse prevention research, Dr. Hecht specializes in developing and evaluating culturally grounded, narrative health messages to engage diverse communities. Through his work on an R01 in the 1990s, called “keepin’ it REAL” (kiR), Dr. Hecht co-founded REAL Prevention and has disseminated and implemented the program in all 50 states and 53 other countries. As co-president of REAL Prevention, Dr. Hecht provides training, consulting, support and evaluation services to organizations interested in adopting of kiR or developing new interventions.

Dr. Hecht earned his Ph.D. from the University of Illinois and is a Distinguished Professor Emeritus at Pennsylvania State University. He has won numerous awards, including the Gerald R. Philips Award for Distinguished Applied Communication Scholarship, two Distinguished Scholarship Awards for the International and Intercultural Division of the National Communication Association, and the Article of the Year Award for SIETAR. Additionally, Dr. Hecht has served on NIH’s Community-Level Health Promotion Review Group, including being selected as its chair, as well as on numerous editorial boards in communication and other fields.

Denver Mayor’s Diversity and Inclusion Awards

Denver Mayor’s Diversity and Inclusion Awards

On September 26, Klein Buendel helped sponsor the 2019 Denver Mayor’s Diversity and Inclusion Awards. The event was themed “Together for the Ages” and hosted by the Denver Commission on Aging for Denver Mayor Michael Hancock. Dr. Barbara Walkosz, KB Senior Scientist, is an appointed member of the Denver Commission on Aging.

By 2030, one in four residents of the city of Denver will be over 60 years of age. The Denver Commission on Aging helps to make Denver the best possible community for older adults through outreach, communication and advocacy, including:

  • Advocating for their rights and concerns
  • Empowering older adults through dissemination of information and sharing community resources
  • Monitoring and recommending legislation and proposed policy changes affecting older adults

The Mayor’s Diversity and Inclusion Awards is an annual program of the agency for Human Rights & Community Partnerships (HRCP). HRCP is the umbrella agency for nine offices and ten commissions that work to create a more just and equitable Denver. Through advocacy, capacity building, collaboration, community engagement, and direct services HRCP works to create lasting change for Denver’s residents. This includes ensuring that people from all corners of the Denver community community are empowered and supported with the innate knowledge that diverse perspectives, skills, and resources strengthen the foundation for lasting solutions.

Inclusivity is the cornerstone of HRCP’s work. They strive to give voices to the voiceless and to create a world class city where everyone matters. Mayor Michael B. Hancock and the community commissioners honored 10 individuals or organizations with the 2019 Mayor’s Diversity and Inclusion Awards.

Responsible Marijuana Vendor Training

Responsible Marijuana Vendor Training

Dr. David Buller, Klein Buendel Senior Scientist and Director of Research, presented recent work by his research team at the Tenth European Society for Prevention Research (EUSPR) Conference and Members’ Meeting in Ghent, Belgium in September. His presentation, “Effects of an Online Responsible Vendor Training for Recreational Cannabis Stores on Sales to Pseudo-intoxicated Customers: Need for Increased Deterrence,” was coauthored by Dr. Gill Woodall, Mr. Andrew Grayson, Ms. Sierra Svendsen, and Ms. Mary Buller from Klein Buendel; and Dr. Robert Saltz from the Pacific Institute for Research and Evaluation.

The advent of recreational cannabis in Canada, Uruguay, and several U.S. states raises the risk of polysubstance-impaired driving. In alcohol markets, training in responsible sales practices is an intervention to reduce sales to intoxicated patrons and thus prevent impaired driving and other harms. Similar training may benefit communities with recreational cannabis sales.

An online responsible marijuana vendor (RMV) training, Train To Tend, was developed with input from state regulators and store personnel. Among its five modules, learning elements taught store personnel to recognize signs of alcohol impairment and intoxication, refuse sales, and understand the risks of driving under the influence of cannabis. A sample of 150 recreational cannabis stores in Colorado, Oregon, and Washington State, USA were enrolled in a randomized controlled trial, half of which were randomly assigned to use the RMV training. Stores were posttested using a pseudo-intoxicated patron (PiP) protocol in which confederate buyers feigned obvious signs of intoxication.

Sales of cannabis to PiPs were refused at only 16 of 144 stores across the three states. There was no difference in refusal rates between intervention and control stores or between stores that used the RMV training or not. In 11 visits, store personnel commented on the buyers’ behavior or expressed concern/suspicion about buyers but sold to them anyway.

Training in responsible sales practices alone did not appear to reduce sales to intoxicated customers. Legal deterrence from making these sales may be insufficient or nonexistent for store management to support adherence to this responsible sales practice. Regulatory actions (such as swift, severe, and certain penalties) may be needed to increase perceived risk with such sales  to achieve training’s benefits.

This research was sponsored by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Train To Tend was programmed by the Creative Team at Klein Buendel.

Dr. David Buller presenting the RMV training program
Smart Choices 4 Teens

Smart Choices 4 Teens

Three Klein Buendel researchers were part of a team that gave two presentations at the Tenth European Society for Prevention Research (EUSPR) Conference and Members’ Meeting in Ghent, Belgium in September. Dr. David Buller, Dr. W. Gill Woodall, and Ms. Julia Berteletti were part of the Smart Choices 4 Teens research team led by Dr. Brenda Miller from the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE).

Smart Choices 4 Teens is an online, interactive, family-based program for parents and older teens designed to reduce teen alcohol use and risky sexual behaviors. The program features three sequential components (parent-teen communication, teen alcohol prevention, and teen romantic relationships) that parents and teens complete separately before working together through a discussion activity at the end of each component. A randomized controlled trial with 411 families found significantly better outcomes for teens in the experimental condition as compared to controls in terms of decreased alcohol use and decreased sexual risk behaviors.

Oral Presentation

Dr. Brenda Miller’s presentation focused on the design of the Smart Choices 4 Teens alcohol prevention component. This module targeted eleven topics: (1) the decision to drink or not drink, (2) social host laws, (3) physical effects of alcohol, (4) signs of alcohol poisoning, (5) social consequences of alcohol, (6) an interactive Blood Alcohol Calculator, (7) myths about alcohol, (8) creating a safety plan for parties, (9) parental influences, (10) refusal skills, and (11) defining a drinking problem. The module incorporated four different activity formats — video narratives, info-gadgets, interactive activities, and structured discussions. Parents and teens engaged in the same materials but did so separately, coming together to choose and discuss hypothetical scenarios that guided the discussion offline. A “nudge” feature was embedded to allow teens to prompt their parent to finish a module and move to the end-of-module offline discussion or vice versa. The nudge feature was used 561 times by 218 users.

Dr. Miller reported that 86% of experimental families began the intervention and 50% of families completed the teen alcohol prevention component. The average time needed to complete the alcohol component was 16 minutes. Parents and teens reported learning new lessons and becoming more comfortable discussing alcohol use together. Barriers to completion included limited understanding of some content and needing additional instructions.

Poster Presentation

Dr. David Buller presented a poster, with analysis led by Dr. W. Gill Woodall, on the effect of teen engagement with Smart Choices 4 Teens. Teens and parents (411 dyads) completed an online baseline survey prior to being assigned to either the intervention or control conditions. Follow-up online surveys were completed 6, 12, and 18 months later. The teen sample was 55% female and 72% non-Hispanic White. The parent sample was comprised predominately of mothers (84.7%).

The Smart Choices 4 Teens website tracked duration of time spent using each of the web-based components. In an analysis of teens who completed the program in the intervention group (n=142), linear regressions tested duration of teens’ time in each online component in the entire program as predictors of teens’ past 30-day alcohol use at the 6-month follow-up. More time spent by teens using interactive activities negatively predicted later alcohol use, as did teens’ time spent viewing videos. Also, teens’ time spent using info-gadget activities had a negative relationship with alcohol use.

The researchers report that activities with interactivity, animations, and video content may produce stronger preventive effects on alcohol use because teens prefer this format over written text in the info-gadgets, have more involvement with them, and/or find characters relatable. These reactions may stimulate deep processing of prevention content.

The Smart Choices 4 Teens research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA020977; Dr. Brenda Miller, PIRE, Principal Investigator). Other authors on Dr. Miller’s research team included Dr. Hilary Byrnes, Ms. Veronica Rogers, and Dr. Joel Grube from PIRE; Dr. Beth Bourdeau from the University of California San Francisco; and Dr. David Buller, Dr. W. Gill Woodall, and Ms. Julia Berteletti from Klein Buendel. Smart Choices 4 Teens was programmed by the Creative Team at Klein Buendel.

Dr. Brenda Miller viewing Smart Choices 4 Teens
Project STRONG Expands into Spanish

Project STRONG Expands into Spanish

Ms. Julia Berteletti, Klein Buendel Research Program Manager, is a Co-Investigator on a new research project aimed at teaching adolescent boys, with their parents, skills on regulating their emotions and how to communicate their feelings.

Emotional regulation is the ability to successfully understand and express one’s emotions (1). The large empirical literature links violent behavior and adolescents who lack this ability. Furthermore, numerous studies show that parental involvement is crucial to offsetting dating violence risk (2).

Northeastern University, in collaboration with Klein Buendel, conducted a pilot study which was funded by the National Institute of Justice and titled “Partner Violence Prevention for Middle School Boys: A Dyadic Web-Based Intervention” (2014-MU-CX-4002). The aim of the study was to develop a web-based intervention to reduce the risk of dating violence among middle-school aged males. The engaging web program was used by parents and adolescents together, with both the parent and the child choosing an avatar, playing games together, and being prompted to discuss the content.

Results showed that families generally found the program helpful and useful (3). Adolescents randomized to the STRONG condition were less likely to report dating violence perpetration events and victimization events when compared to the control group (3). Additionally, adolescents in the STRONG condition reported an increase in a number of emotional regulation measures compared to control participants (3).

The new Project STRONG R01 study will be conducted in a larger randomized controlled trial titled “Project STRONG: A Web-Based Dating Violence Prevention Program for Parents and Middle School Boys”. The web-based program will be translated and developed in Spanish and will be tested for its ability to reduce the risk of dating violence among both English- and Spanish-speaking middle-school aged males. Again, parents and their sons will complete the program together.

The research is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD097126; Dr. Chris Houck and Dr. Christine Rizzo, Principal Investigators). Ms. Berteletti will be collaborating with Dr. Chris Houck of Rhode Island Hospital and Dr. Christine Rizzo of Brown University.


1. Houck CD, Hadley W, Barker D, Brown LK, Hancock E, Almy B. An emotion regulation intervention to reduce risk behaviors among at-risk early adolescents. Prev Sci. 2016;17(1):71-82. doi: 10.1007/s11121-015-0597-0
2. Lundgren R, Amin A. Addressing intimate partner violence and sexual violence among adolescents: emerging evidence of effectiveness. J Adolesc Health. 2015;56(1 Suppl):S42-S50. doi: 10.1016/j.jadohealth.2014.08.012
3. National Criminal Justice Reference Service; Rizzo CJ, Houck C. Summary Report: Partner Violence Prevention for Middle-School Boys: A Dyadic Web-Based Intervention Study (Project STRONG). Available at: Published January 2019. Accessed August 21, 2019.