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Effects of an Online Responsible Vendor Training for Recreational Marijuana Stores

Effects of an Online Responsible Vendor Training for Recreational Marijuana Stores

The Train To Tend® responsible marijuana vendor (RMV) training research team recently published results from online RMV training on responsible sales for recreational marijuana store personnel as an abstract for the Annals of Behavioral Medicine. The Train To Tend research team is led by Dr. David Buller from Klein Buendel who would have presented the findings at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

Recreational marijuana regulations have been designed, in part, to ensure that cannabis products are sold only to adults over the age of 21 who provide state-approved identification (ID). The Train to Tend online RMV training was developed with input from state regulators and recreational marijuana store personnel to train store staff. The training consists of five modules with interactive learning elements that cover state laws, ID checking, health effects of marijuana, driving under the influence, refusal of sales to intoxicated customers, and store processes, such as product labeling and tracking.

A sample of 175 recreational marijuana stores in Colorado and Washington were selected for a randomized controlled trial with sales to pseudo-underage customers. Of the 175 stores, 75 were assigned to the control condition (usual and customary training) and the remaining 100 were given the online RMV training. At baseline, sales of marijuana to pseudo-underage buyers were refused at 93% of 349 visits to stores across the two states. After adjusting for store characteristics, there was no difference in change in refusal rates between treatment groups from baseline, to a 3-month posttest, or a 9-month posttest. For the intervention stores, training uptake was not related to refusal rate and nearly all recreational cannabis stores refused sales to young patrons who failed to produce appropriate ID.

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). Co-authors include Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation; Dr. Gary Cutter from the University of Alabama, Birmingham; and Dr. Gill Woodall, Andrew Grayson, Mary Buller, Sierra Svendsen, and Lucia Liu from Klein Buendel.

Mothers’ Support for Laws Restricting Indoor Tanning by Minors

Mothers’ Support for Laws Restricting Indoor Tanning by Minors

The Health Chat research team published some findings related to indoor tanning from their Facebook-delivered cancer risk reduction intervention and randomized trial with mothers and teen daughters as an abstract in the Annals of Behavioral Medicine. The research team would have presented the work at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

Indoor tanning is associated with increased risk for melanoma, especially in young women. Several states restrict indoor tanning by minors or require parental permission. The authors of this abstract hypothesize that mothers’ awareness of state laws related to indoor tanning by youth may reduce their permissiveness for daughters to use tanning facilities.

A total of 777 mothers (and their daughters) from 34 states that do not ban indoor tanning participated in the trial. Less than 20% of mothers (and fewer daughters) accurately reported whether their state has an age restriction or parental permission requirement for minors to indoor tan. More than 50% of the mothers supported banning indoor tanning by minors. However, the mothers reported varying levels of advocacy that they would be willing to demonstrate related to enacting state-level policy to restrict indoor tanning by minors (e.g., sign a petition, contact an elected representative, testify to a state legislative committee). 

The authors conclude that: “Efforts to inform mothers and daughters may be needed to create a norm against indoor tanning, to prevent moms from permitting indoor tanning by daughters, and to build support for further restrictions on minors’ access.”

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

E-Training to Enhance the Care of Aged and Dying Prisoners

E-Training to Enhance the Care of Aged and Dying Prisoners

The health care needs of aged, chronically ill, and dying inmates in correctional settings face growing demands. The Enhancing Care for the Aged and Dying in Prisons (ECAD-P) research team published insights from a geriatric care learning program for corrections staff as an abstract for the Annals of Behavioral Medicine. The ECAD-P research team is led by Dr. Susan Loeb from Penn State University and Dr. Valerie Myers from Klein Buendel. They would have presented the work at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

The number of older inmates in the United States continues to grow and best practices for managing geriatric issues and end-of-life (EOL) care have not been adapted for use in corrections settings. In response, ECAD-P team has developed a computer-based learning program for corrections staff comprised of six modules that address EOL and geriatric care concerns in prisons.

After conducting two rounds of usability testing at two prisons in different states, the ECAD-P program entered full-scale testing at seven state prisons. A total of 241 individuals consented to participate and 173 individuals completed all training modules and posttests. Outcomes revealed that the ECAD-P training program was acceptable, feasible, and usable in the corrections staff setting. The research team also found that corrections staff improved their knowledge of geriatric and EOL care of inmates overall after completing the training.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators and co-authors on this abstract also include Dr. Erin Kitt-Lewis from Penn State University; Dr. Rachel Wion from the Indiana University School of Nursing (formerly Penn State University); Julie Murphy from the King’s College Nursing Program; and Tiffany Jerrod, formerly of Klein Buendel.

Health Misinformation in Participant Comments in a Facebook-Delivered Cancer Risk Reduction Intervention

Health Misinformation in Participant Comments in a Facebook-Delivered Cancer Risk Reduction Intervention

Little is known about how how participants in a health intervention share health misinformation via social media platforms. The Health Chat research team published insights from their Facebook-delivered cancer risk reduction intervention and randomized trial with mothers and teen daughters as an abstract for the Society of Behavioral Medicine (SBM). The lead author, Kelsey Arroyo, from the University of Connecticut, would have presented the work at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

For this study, the researchers examined 175 comments made to 42 randomly-selected Facebook posts on different health topics such as substance use, indoor tanning, vaccines, mental health by study participants. The Facebook groups were moderated by health professionals. The participant comments were coded as sharing an opinion, a personal experience, an intention, or information. Comments were analyzed for whether misinformation was conveyed. According to the authors, “misinformation was defined as a fact, belief, opinion, or action that is not supported by scientific evidence.”

Analysis showed that more than three-quarters of comments shared a personal experience. Overall, less than one-fifth of the comments conveyed misinformation, and more than half of the misinformation was conveyed in comments that shared a personal experience.

This research is funded by a grant from the National Cancer Institute (CA192652; Dr. David Buller, Klein Buendel, and Dr. Sherry Pagoto, University of Connecticut, Multiple Principal Investigators). Collaborators and co-authors on the SBM abstract include Kelsey Arroyo, Jared Goetz, and Dr. Molly Waring from the University of Connecticut; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kim Henry from Colorado State University; Dr. Jerod Stapleton formerly from the Rutgers Cancer Institute of New Jersey; and Julia Berteletti and Dr. Barbara Walkosz from Klein Buendel.

Lessons Learned: Accessing Sites for Correctional Research

Lessons Learned: Accessing Sites for Correctional Research

Dr. Erin Kitt-Lewis from Penn State University presented insights into accessing correctional facilities for research at the 32nd Annual Scientific Sessions virtual conference of the Eastern Nursing Research Society on March 26-27, 2020. Klein Buendel Senior Scientist, Dr. Valerie Myers, was a co-author on the presentation.

Despite the imperative to engage in research in corrections, researchers face many challenges due to the restrictive nature of this setting. Dr. Kitt-Lewis shared many of the lessons learned by this collaborative research team as they worked to secure diverse prison and jail settings to research, develop, and test the Enhancing Care for the Aged and Dying in Prison program.

Lessons learned included the discovery of contextually-specific constraints such as the closing or consolidating of services or facilities, managing staffing constraints, relocating staff, ascertaining and adhering to policies and administrative directives, and working within the guidelines of the review board of the correctional system.

Establishing and maintaining relationships with key stakeholders in corrections were also important aspects of this research. In her presentation, Dr. Kitt-Lewis discussed developing networking opportunities such as connecting via social media like LinkedIn, attending corrections conferences, and discussing potential research opportunities to help build relationships with key stakeholders and decision-makers. Additional perceptions from the field included identifying potential barriers or constraints to accessing correctional sites, and sustaining relationships post-research via ongoing communication such as sharing periodic updates, final reports, and publications with partners.

The correctional system has often been called a “closed” system due to the difficulty faced by researchers in attempting to access and conduct research. However, establishing well-defined strategies to conduct research in the system appears to create efficiency and promote much needed health-related research in the correction setting. Research outcomes that are contextually-specific can support and foster equitable care for people who are incarcerated.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the work presented, in addition to Dr. Erin Kitt-Lewis, include Dr. Susan Loeb and Kaléi Kowalchik from Penn State University; Dr. Rachel Wion from Indiana University School of Nursing; Julie Murphy from King College Nursing Program; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.

Implementing E-Training for Geriatric and End-of-Life Care in Corrections

Implementing E-Training for Geriatric and End-of-Life Care in Corrections

Dr. Susan Loeb from The Pennsylvania State University College of Nursing is presenting on the creation of a computer-based learning (CBL) program for corrections staff at the 32nd Annual Scientific Sessions virtual conference of the Eastern Nursing Research Society on March 26-27, 2020. Klein Buendel Senior Scientist, Dr. Valerie Myers, is a co-author on the presentation.

Experts in corrections have identified the care of older individuals who are incarcerated as a high priority area for research and policy. Therefore, there is a need to provide evidence-based training tailored to frontline corrections personnel who are charged with the care and oversight of aged and dying incarcerated individuals. In response, the research team developed, implemented, and tested a CBL program that aligned with contextual environment constraints and the infrastructure-specific needs of corrections.

The virtual presentation will describe how the adoption mechanisms and support systems were integrated from set up to full-scale usability testing of the CBL program, Enhancing Care for the Aged and Dying in Prison (ECAD-P) for corrections staff. Specifically, factors that affect adoption and support systems were identified, examined and implemented at each phase of the development and implementation process of ECAD-P. In the Set-Up phase, the format of a paper-pencil toolkit was not sustainable for long-term, broad dissemination of the program, so support systems were evaluated to determine the capabilities of CBL. Throughout the development, Expert and Community Advisory Boards critically examined the content and programming measures of the product to ensure the product complied with usual practices and institutional constraints.

During testing, small scale usability-testing was conducted to determine human capacity, infrastructure capabilities, reporting systems, and program design and function. In going to full-scale, large-scale usability testing provided valuable insights on implementation considerations, such as leadership, communication, policy, and culture of institution. Consideration of adoption mechanisms and support systems ultimately allowed for researchers to refine ECAD-P for future, effective, large-scale dissemination.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the work presented include Dr. Erin Kitt-Lewis and Kaléi Kowalchik from The Pennsylvania State University College of Nursing; Dr. Rachel Wion from Indiana University School of Nursing; Julie Murphy from King College Nursing Program; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.

A Tablet-delivered Intervention to Reduce Risky Behavior in Adolescents

A Tablet-delivered Intervention to Reduce Risky Behavior in Adolescents

Klein Buendel collaborator, Dr. Christopher Houck from Rhode Island Hospital, will present findings from Project TRAC at the Society of Research on Adolescence Biennial Meeting in San Diego, California, March 19-21, 2020. His presentation will also include a demonstration of the targeted games used in the intervention.

The team initially developed and validated an Emotion Regulation (ER) intervention for reducing risk behaviors among early adolescents. Project TRAC showed that adolescents who learned about sexual health information with ER content were significantly less likely to transition to sexual activity. Despite the promise of targeting ER during early adolescence to prevent risk behaviors, discussions with community partners suggest that the original facilitator-led small-group format is difficult to sustain. Disseminating this prevention approach required a format that was less reliant on specialized training that could be easily implemented to an individual format. Therefore, through advisory panels of early adolescents and consultation from a group of experts in the field, Project TRAC was translated from a small-group format to a tablet-delivered, game-based program.

Acceptability testing took place with ten adolescents followed by 85 adolescents who participated in a small randomized pilot trial to assess the feasibility of the digital intervention as well as preliminary assessment of short-term changes in ER. Those randomized to the intervention condition completed four computerized modules that taught emotion concepts through games and instructional videos. Control participants were waitlisted to complete the intervention at the end of the study and all adolescents completed surveys at baseline and one month later.

Participants positively rated the intervention with a majority completing all four modules. Intervention participants self-reported significant improvements, including emotional awareness, perceived access to ER strategies, use of the strategies taught in the intervention, intentions to use these strategies, emotional knowledge, and perceptions that emotions are changeable. They also reported a moderate effect of poorer perceptions of abilities to manage positive emotions.

Results suggest that a tablet-based intervention providing ER training was able to affect adolescents’ use of ER behaviors, understanding of emotions, and perceptions of emotional competence. Linking ER training to specific areas of risk (sexual health, substance use, or violence prevention) in the developmental window when risk behaviors are beginning, such as early adolescence, may prevent risk behaviors for many young people. Dissemination of evidence-based interventions through tablet formats may also improve the reach of effective interventions.

This research is funded by a grant from the National Institute of Child Health and Human Development (HD089979; Dr. Christopher Houck, Principal Investigator). Other collaborators include Wendy Hadley from the University of Oregon; Crosby Modrowski and Kelsey Bala from Brown University; Brittany Wickham from Villanova University; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.

An Implementation Model for the Cost-effective Scale-up of the Sun Safe Workplaces Program

An Implementation Model for the Cost-effective Scale-up of the Sun Safe Workplaces Program

Dr. David Buller and Dr. Barbara Walkosz from Klein Buendel presented a poster on a new implementation model for the cost-effective scale-up of an occupational sun protection program at the 12th Annual Conference on the Science of Dissemination and Implementation in Health in Washington, DC, December 4-6, 2019. The poster was nominated for Best Poster from the Prevention and Public Health Division.

Scale-up is the effort to increase the impact of successful programs to benefit more people on a lasting basis. Scale-up efforts must increase reach, retain effectiveness, and lower costs to provide greater access to benefits and close the research-to-practice gap between effective programs and real-world application. This project is studying the nationwide scale-up of an occupational sun safety intervention, Sun Safe Workplaces, with state Departments of Transportation (DOTs), a public works sector with thousands of outdoor workers.

Costs of national distribution can be daunting and influence intervention intensity and program effectiveness. Identifying cost-effective scale-up strategies is essential for moving research into practice. The new framework draws upon existing implementation models, including those developed for occupational health and safety, and operationalizes implementation for scale-up within RE-AIM. The RE-AIM framework was adapted for this new framework by incorporating cost as a primary factor.

In a randomized trial, Sun Safe Workplaces (SSW) is assessing implementation rate and costs associated with two methods of scaling-up SSW. The original intervention depended on personal visits with managers, materials promoting sun protection policies and education, in-person sun safety training for employee groups, and on-going follow-up communication with managers supporting sun safety (SSW-IP), a resource-intensive form of intervention. Now SSW-IP is being contrasted to a scale-up strategy that uses web-based and telephone conferencing, responsive training platforms, and electronic resources for virtual contacts and training (SSW-T). Technology-based programs have the potential to deliver standardized, engaging content and increase portability while decreasing cost of delivery to enable reaching more employers when scaled-up to nationwide distribution. Districts within DOTs are randomized to one of the two scale-up methods. The SSW-IP and SSW-T interventions are being delivered in 21 state DOTs with 141 districts.

This research is funded by a grant from the National Cancer Institute (CA134705; Dr. David Buller and Dr. Barbara Walkosz, Multiple Principal Investigators). Additional poster coauthors include Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; and Mary Buller, Rachel Eye, Andrew Grayson, and Savanna Olivas from Klein Buendel.

Parents’ Reports of School Communication on Sun Safety

Parents’ Reports of School Communication on Sun Safety

The U.S. Surgeon General and the Centers for Disease Control and Prevention have called on the nation’s schools to help prevent skin cancer by implementing sun safety practices and policies. The Sun Safe Schools program was designed by Klein Buendel researchers and collaborators in response to those calls to action. The program was implemented and evaluated with 118 public elementary schools in California.

Dr. David Buller, Klein Buendel Director of Research, presented data on the impact of the Sun Safe Schools intervention on parents’ reports of sun safety communication from schools and children’s sun protection behavior at the 12th Annual Conference on the Science of Dissemination and Implementation in Health in Washington, DC, December 4-6, 2019.

Schools randomized to the Sun Safe Schools intervention group (N=58) received support for implementing school sun safety practices by trained coaches over 20 months. Based on Diffusion of Innovations Theory, support and resources for implementation were tailored to school principals’ readiness to implement. Parents completed an online posttest survey through invitations sent by principals or while attending parent-oriented school events. Parents were surveyed to test the hypothesis that parents would report more communication about sun safety at schools receiving the intervention than at control schools.

The Sun Safe Schools program appeared to increase communication on sun safety and the use of student sun protection. Parents in intervention schools were more likely to report receiving information about sun safety from the school and that their children wore sun-protective clothing than in control schools. The improvement in sun safety appeared to result from policy implementation. In schools where principals reported implementing sun safety practices at posttest, parents reported that children spent less time outdoors and had fewer sunburns than at non-implementing schools. Further, parents who received information about sun safety from the school reported more sun protection for their child than parents not receiving the information.

In summary, a school district-level policy, combined with active technical support for schools within the district, appears to be effective at increasing implementation of school sun safety practices to help protect children from solar ultraviolet radiation, the primary risk factor for the development of skin cancer.

The Sun Safe Schools program is a joint research effort of Claremont Graduate University (CGU), the Kaiser Permanente Center for Health Research, and Klein Buendel. The 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, CGU, and Dr. David Buller, Multiple Principal Investigators). Other collaborators 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 Chapman University; and Julia Berteletti and Mary Buller from Klein Buendel.

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