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Alcohol Sale Refusals to Pseudo-Intoxicated Patrons In Primarily Spanish-Speaking Premises

Alcohol Sale Refusals to Pseudo-Intoxicated Patrons In Primarily Spanish-Speaking Premises

Klein Buendel Senior Scientist Dr. W. Gill Woodall presented data on alcohol over-service from the WayToServe-Español project on a panel discussion at the 42nd Annual Scientific Meeting of the Research Society on Alcoholism held in Minneapolis, Minnesota on June 22-26, 2019.

The over-service of alcohol to individuals who show signs of intoxication is problematic for public health because it contributes to drunk driving and alcohol-related injury and death. In addition, little is known about alcohol over-service in premises where business is conducted primarily in Spanish because these alcohol service situations have been understudied.

Dr. Woodall presented data from a baseline assessment of a randomized trial that investigated Responsible Beverage Service (RBS) training in predominately Spanish-speaking premises in Texas and New Mexico. The research provides a unique opportunity to contrast two states and communities with similar populations, but different alcohol policies and practices.

Hispanic confederates were trained to enact evidence-based signs of intoxication while attempting to purchase an alcoholic beverage in Spanish. Over-service was measured using a pseudo-intoxicated patron protocol. Baseline refusal rates were 12% in Texas and 34% in New Mexico. On the panel, Dr. Woodall discussed the implications of these baseline data for RBS training in minority communities and alcohol policy.

This research is funded by the National Institute of Minority Health and Health Disparities at the National Institutes of Health (MD010405; Dr. W. Gill Woodall, Klein Buendel, Principal Investigator). Collaborating co-authors on the presentation included Dr. Robert Saltz from the Pacific Institute for Research and Evaluation, Dr. David Buller from Klein Buendel, Dr. Victoria Sanchez and Dr. Randall Starling from the University of New Mexico, and Dr. Areli Chacon Silva and Dr. Frank Perez from the University of Texas at El Paso.

Refusal of Pseudo-intoxicated Customers at Retail Marijuana Stores

Refusal of Pseudo-intoxicated Customers at Retail Marijuana Stores

Klein Buendel Senior Scientist, Dr. David Buller presented a poster at the Society for Prevention Research Annual Meeting in San Francisco, California in May. The poster presented insights on whether personnel in recreational marijuana stores refuse sales to buyers who appear to be intoxicated.

Recreational marijuana is sold by state-licensed stores in seven U.S. states. Like alcohol, sales are prohibited to persons younger than age 21 and sometimes to persons who are apparently intoxicated. A sample of 150 licensed retail stores in Colorado, Oregon, and Washington were selected from state regulatory agency lists. A majority of stores sold both recreational and medical marijuana. The sample was stratified between the largest metropolitan area in each state (Denver, Portland, and Seattle) and nearby regions with smaller cities.

Pseudo-patron assessment teams comprised of a ‘buyer’ and an ‘observer’, visited each store once from August to October 2018. Buyers attempted to enter the premises while feigning obvious signs of intoxication (for example: slurred speech, stumbling, dropped change or ID) and attempted to purchase a low-cost cannabis product. Observers recorded whether buyers gained entry and if the clerk offered to sell marijuana (no actual purchases were made).

Refusal rates were rare. Overall, refusal rates were slightly higher in the states of Colorado and Oregon than in Washington. A state law that explicitly prohibited sales in Oregon may have slightly decreased sales there, while refusals in Colorado may be attributed to the wide-scale use of security guards checking IDs at entrances. These high rates of sales to apparently intoxicated customers are a cause for concern, especially in light of research indicating that the combination of alcohol and marijuana intoxication appears to severely impair driver performance.

This research project is funded by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Additional collaborators include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in Oakland, California; and Dr. Gill Woodall and Andrew Grayson from Klein Buendel.

Nightlife Risk from Alcohol and Drug Use

Nightlife Risk from Alcohol and Drug Use

Two Klein Buendel researchers are part of a team that presented two posters at the Society for Prevention Research Annual Meeting in San Francisco in May. Dr. David Buller and Julia Berteletti are part of the Nightlife Safety Plans research team led by Dr. Brenda Miller from the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE).

Nightclubs are high-risk settings for overuse of alcohol and other drugs and physical and sexual aggression among young adults. Nightlife Safety Plans (NSP) is a group-based, tablet app-delivered intervention designed for patrons arriving together. NSP addresses these unwanted outcomes and encourages social groups to recognize early indicators of risk. Actions steps are provided via tablet app to de-escalate the situation. 

Nightclub Group Gender Composition

The first poster examined the influence of social group gender composition on alcohol outcomes and on the effectiveness of the NSP intervention across different group compositions (all-female, all-male, mixed gender). The sample included 959 nightclub patrons who formed 359 groups recruited from seven clubs, across 41 different events. Less than half of the participants were female and the average age was 26. All data was collected anonymously.

Outcome variables included overall number of the group’s safety actions taken to keep group members safe, the highest number of safety actions by any single group member, and breath alcohol concentration (BAC) at exit.  Mixed model regressions examined the main effect of group composition and its interaction with the intervention as a predictor of outcomes after controlling for individual and group characteristics. Those in the intervention condition reported higher numbers of safety actions by any single member in all female groups and mixed gender groups, but not in all-male groups. There were no significant interactions for intervention status by group composition for either BAC at exit or the number of group actions taken as assessed by the overall group.  This poster was first-authored and presented by Dr. Brenda Miller from PIRE.

Drinking Group Cohesion

The second poster examined the hypothesis that club patrons who perceive greater cohesion in their group implement fewer protective strategies and use higher levels of alcohol and other drugs. Could being part of a more cohesive peer drinking group lead to a false sense of security and letting down one’s guard, which could lead to more risk taking? The sample included 815 nightclub patrons in the San Francisco area, arriving in 324 distinct groups, from seven clubs hosting electronic music dance events across 30 different evenings. Less than half of the participants were female and the average age was 27. Club patrons were surveyed anonymously and completed breath tests as they entered and exited clubs. Oral fluid samples at exit assessed drug use.

Patrons reported perceived cohesion with their group members (for example, people in the group are willing to help each other), as well as use of actions to keep oneself safe, actions to keep group members safe, and actions in response to group alcohol and other drug problems. Mixed model regressions examined group cohesion as a predictor after controlling for individual and group characteristics, and past 30-day drinking/drug use at clubs. Findings partially confirm the hypothesis. Patrons who perceived greater group cohesion engaged in fewer preventive strategies to keep themselves and their group safe during the night and those who perceived greater group cohesion implemented fewer actions in response to group AOD problems. This poster was first-authored and presented by Dr. Hilary Byrnes from PIRE.

The NSP research is 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). Research team collaborators/authors include Dr. Brenda Miller, Dr. Hilary Byrnes, Dr. Joel Grube, and Dr. Beth Bourdeau, Dr. Mark Johnson, and Veronica Rogers from PIRE; and Dr. David Buller and Julia Berteletti from Klein Buendel. The NSP tablet app was developed by Klein Buendel’s Creative Team.

Inmate Caregiver Training in Geriatrics and End-Of-Life

Inmate Caregiver Training in Geriatrics and End-Of-Life

Dr. Susan Loeb from Penn State University presented on the development of computer-based learning modules for caregivers of the aged and dying in prisons at the 31st Annual Scientific Sessions of the Eastern Nursing Research Society (ENRS) held in Providence, RI on April 3-5, 2019. This research is being conducted with Klein Buendel Senior Scientist, Dr. Valerie Myers, a co-author on the presentation.

More men and women are aging and facing end-of-life (EOL) while incarcerated. Early research by this research team found that computer-based training for inmates assisting staff in geriatric and EOL care was feasible. This collaborative team of nurse scientists, small business partners, and the correctional community are working to advance the quality of care provided for those aging and dying in our nations’ correctional institutions. Specifically, the purpose of the research presented at ENRS was to identify inmate peer caregiver training needs, and discover priority content areas and core values for inmate computer-based modules with the help of stakeholders and experts.

Six focus groups were conducted with stakeholders at one men’s and one women’s state correctional institution in a Mid-Atlantic state. Stakeholders included information technology and human resources staff, interdisciplinary front line staff who oversee inmate peer caregivers, and inmate peer caregivers. A content analysis identified content areas and core values. An Advisory Board of experts in EOL and geriatric care, corrections health, and corrections training, suggested combining some of the priority content areas. The resulting priority content areas for the initial Inmates Care modules were Universal Precautions, Role of the Inmate Caregiver in the Final Hours, and Loss and Grief. The core values identified for the inmates training were respect, dignity, and compassion. The next steps of the research project include completing three prototype modules, testing them for usability, and developing a specifications document for technology programming and production congruent with correctional facility security precautions.

This research was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG057239; Dr. Susan Loeb, Principal Investigator) and Dr. Valerie Myers, Co-Investigator. Additional collaborators on the work presented at the conference include Dr. Erin Kitt-Lewis, Dr. Rachel Wion, and Julie Murphy from the Penn State University College of Nursing, and Tiffany Jerrod and Morgan Carter from Klein Buendel. The technology-based modules are being developed by the Creative Team at Klein Buendel.

Implementation of Sun Safety Policies in Public Elementary Schools

Implementation of Sun Safety Policies in Public Elementary Schools

Klein Buendel Research Program Manager, Julia Berteletti, presented insights from a randomized controlled trial that tested a technical assistance program designed to help principals implement district sun safety policies in elementary schools at the 40th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine, March 6-9, 2019 in Washington, DC.

The Centers for Disease Control and Prevention (CDC) and U.S. Surgeon General have advised the nation’s schools to adopt and implement sun protection policy to reduce children’s exposure to solar ultraviolet radiation to prevent skin cancer. A total of 118 elementary schools from 40 California public school districts that had adopted a school board-approved policy for sun safety were recruited and the principal and a teacher at each school reported on school sun protection practices at baseline and posttest.

Half of the schools were randomly assigned to receive the 20-month Sun Safe Schools intervention, delivered by trained Sun Safety Coaches who met with principals, described the district policy, helped them select and plan implementation of sun safety practices, and provided support and resources matched to the principal’s readiness to implement practices based on Diffusion of Innovation Theory. Control schools received a minimal information treatment containing basic school sun safety information from the CDC, the National Association of State Boards of Education, and U.S. Surgeon General.

Compared to controls, principals at intervention schools reported implementing more sun safety practices in general, whether present in the district’s written policy or not. Similarly, teachers at intervention schools reported implementing a larger number of sun safety practices in general, including practices in their district’s written policy or not, compared with control schools. Overall, the intervention was effective at increasing sun safety practices in public elementary schools. However, convincing school districts to adopt policies may be only the first step in improving sun safety practices becasue districts need to actively disseminate the new policy to schools and provide assistance and materials to facilitate implementation.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (HD074416; Dr. Kim Reynolds, Principal Investigator). Collaborators in addition to Julia Berteletti, include Dr. Kim Reynolds and Kim Massie from Claremont Graduate University in California; Dr. David Buller and Mary Buller from Klein Buendel; Dr. Jeff Ashley from Sun Safety for Kids in, California; and Dr. Richard Meenan from Kaiser Permanente Center for Health Research in Oregon.

Mothers’ Beliefs about Adolescent Marijuana Use

Mothers’ Beliefs about Adolescent Marijuana Use

Marijuana laws are changing rapidly in the United States, which poses potential challenges for parent-child communication about avoiding marijuana use during adolescence. Klein Buendel Research Program Manager, Julia Berteletti, presented insights from a Facebook-delivered intervention and randomized trial with mothers and teen daughters at the 40th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM), March 6-9, 2019 in Washington, DC.

Baseline survey responses, a sample of posts on preventing marijuana use, and comments were analyzed for understanding mothers’ and daughters’ marijuana use and beliefs about marijuana. The research was testing mothers’ engagement with a social media campaign on adolescent health delivered via private Facebook groups. The sample was comprised of over 800 mothers with adolescent daughters aged 14-17 from 34 U.S. states. As the primary trial purpose was to prevent indoor tanning, eligibility included residing in one of 34 states without a complete ban on indoor tanning for minors. Of these states, 15 have legalized medical marijuana sales, three have legalized medical and recreational sales, and 16 have not legalized sales of marijuana.

Both mothers and daughters completed a baseline survey. Overall, mothers believed that marijuana is harmful for adolescents. Fewer daughters used marijuana than mothers, and daughters felt marijuana use was less harmful than mothers. Both mothers and daughters who used marijuana found it less harmful than non-users. Compared to non-recreational states, mothers in states with recreational marijuana sales felt it was more harmful, but state laws did not significantly affect use by mothers or daughters.  

Facebook comments supporting marijuana use from mothers pertained to benefits of cannabinoids over opioids and providing daughters with information to make their own choices, for example. Negative comments included adverse effects on developing brains, lack of research, and dangers of it being “laced” with other drugs. Mothers also shared reasons to say “no” and how to discuss long-term effects with their daughters.

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

Using E-Training to Enhance Geriatric and End-of-Life Care in Prisons

Using E-Training to Enhance Geriatric and End-of-Life Care in Prisons

Klein Buendel Senior Scientist, Dr. Valerie Myers, presented preliminary findings from a project that provides e-training of inmate peer caregivers to enhance geriatric and end-of-life (EOL) care in prisons at the 40th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM), March 6-9, 2019 in Washington, DC.

The United States has an incarceration rate of 655 people per 100,000, making it the highest globally. The older adult segment of the prison population has more than tripled since 1990 and their health issues are comparable to those of free people who are 10-15 years their senior. Inmates over the age of 55 have a death rate that is 10 times that of prisoners aged 25-34. United States prison systems are facing increased demands in caring for aged and dying inmates. A systematic review revealed that inmate peer caregivers can figure prominently in delivery of EOL care in prison. However, the degree of training received by inmate peer caregivers varies widely.

The lack of consistent training points to a need for evidence-based, current, and readily accessible training for this population to mitigate the growing need for EOL care in United States prisons. In response to this need, the E-training of Inmate Peer Caregivers for Enhancing Geriatric and End-of-Life Care in Prisons project, will demonstrate the scientific merit and feasibility of developing cutting edge, media-rich learning modules to train inmate peer caregivers in geriatric and EOL care. The aims of the project are to: (1) transform best practices in inmate peer caregiving into a comprehensive training program that consists of media-rich and highly interactive computer-based learning modules for providing geriatric and EOL care to their peers; and (2) conduct in-person usability testing of the media-rich and highly interactive web-based prototypes with inmates who are currently Mental Health Peer Support Specialists (that is, prisoners who are experienced caregivers, but naïve to geriatric and EOL care) and prison staff to evaluate the user interface, ease of use, and perceived barriers in order to refine and optimize the product.

Focus groups were conducted with three different groups, inmates, IT staff, and interdisciplinary staff, at a men’s and a women’s state correctional institution to inform content and program development of the training modules. Focus group participants prioritized the Universal Precautions, Loss/Grief, and Role of Inmate Caregivers in the Final Hours modules. These modules will be programmed and tested in state prisons in a mid-Atlantic state. The System Usability Scale, a validated tool for assessing the usability and acceptability of technological products, will serve as the primary outcome.

This research was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG057239; Dr. Susan Loeb, Principal Investigator) and Dr. Valerie Myers, Co-Investigator. Additional collaborators on the work presented at the conference include Dr. Erin Kitt-Lewis, Dr. Rachel Wion, and Julie Murphy from the Penn State University College of Nursing, and Tiffany Jerrod and Morgan Carter from Klein Buendel. The technology-based modules are being developed by the Creative Team at Klein Buendel.

Using Project Management Skills in Behavioral Research

Using Project Management Skills in Behavioral Research

Research projects have various moving parts throughout their lifespan needing to be completed within a certain time frame and budget as outlined in the grant awarded. Project management skills are crucial in ensuring all phases, tasks, and logistics of a research project are organized and completed within deadline and scope.

The workload of a project is driven by how each aim breaks down into a phase, each with its own specific deliverables to be fulfilled and unique timeline to be met. As each phase of a project moves forward, the responsibilities are often compounded due to overlapping timelines, creating an increased need to think ahead and utilize efficient multi-tasking and organizational skills.

Research Project Management Phases

  • Determining and communicating the scope derived from the grant aims and methods;
  • Developing timelines;
  • Protocol development (such as recruitment, screening, data entry, intervention, data management, and adverse event processing);
  • Obtaining necessary institutional approvals;
  • Staff identification/hiring, training, and evaluation;
  • Goal setting including incremental goals as well as larger overarching goals;
  • Project implementation;
  • Delivering objectives including communication of progress toward objectives;
  • Tracking budgeted and expended costs;
  • Required reporting to aid in communicating progress; and
  • Problem-solving as issues inevitably arise.

Communication is a key component to ensuring a smooth flow of the deliverables throughout the project. All personnel on a project need to maintain the same vision and goals. This can often be accomplished using regular meetings, phone calls, emails, and reports. Beyond the regular means of communication, a more comprehensive system such as project management software can be used to keep track of deliverables and deadlines.

Klein Buendel Research Program Manager, Julia Berteletti, organized and participated in a research project management Pre-Conference Workshop at the 40th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM), March 6-9, 2019 in Washington, DC. Co-presenters included Jessica Bibeau and Jared Goetz from the University of Connecticut, and Kim Massie from Chapman University in California. The presenters have been coordinating multi-site research projects from coast-to-coast with each other for several years. Ms. Berteletti explained, “Our projects run on effective partnerships. Facilitating teamwork is one of my favorite parts of my job. It meant a lot to me for us to share our methods for effective collaboration and project management with other research teams.”

The SBM seminar provided a guide for managing a research project using a project management approach which included: (a) understanding the scope, (b) setting goals, (c) considering the costs, (d) implementation (intervention/data collection), and (e) close-out. A hypothetical project was used to present each part of the approach. Team organization, communication, important considerations, timelines, charts, and reports were reviewed to aid in organization, and project management software ideas were provided along with a tutorial of the Basecamp software.

Developing Geriatric and End-of-Life E-training For Inmate Peer Caregivers

Developing Geriatric and End-of-Life E-training For Inmate Peer Caregivers

Dr. Susan Loeb from Penn State University presented on the development of computer-based learning modules for caregivers of the aged and dying in prisons at the 11th Annual Conference on the Science of Dissemination and Implementation in Health in Washington DC, December 3-5, 2018. This research is being conducted with Dr. Valerie Myers at Klein Buendel (KB), a co-author on the presentation.

The increasing numbers and complex needs of aged and dying inmates intensifies the burden of care and costs incurred by prisons. In an initial study (NR011874), best practices in the community were adapted in the Toolkit for Enhancing End-of-Life Care (EOL) in Prisons to train prison staff in EOL care. The print-based Toolkit was well received; however, not well suited for dissemination and lacked geriatric content. The Toolkit was transformed and expanded into Enhancing Care of the Aged and Dying in Prisons (ECAD-P) computer-based learning (CBL) modules in a second study (AG049570). ECAD-P development revealed the need to develop e-training for inmates to assist staff as caregivers for aged and dying inmates.

The purpose of the third study, which was presented at the D&I Conference, is to transform best practices in inmate peer caregiving into a comprehensive training program  that consists of media-rich and interactive computer-based learning modules for providing geriatric and EOL care to peers (i.e., prisoner to prisoner). Focus groups with inmate caregivers, prison staff, and training staff were conducted to determine a menu of CBL modules. An Advisory Board of experts in EOL care, geriatrics, ethics, and corrections health informed the selection of modules for development. Usability testing will soon be conducted in one men’s and one women’s prison with inmates who are experienced in providing mental health peer support, but have not been caregivers for their aged and dying peers. Focus group data will be analyzed using thematic analysis. Usability data will be analyzed using descriptive statistics and content analysis. Data are currently being collected. Analysis will be complete in October and the presentation completed by November.

The Prisoner to Prisoner (P2P) project allows the creation of innovative technology while being mindful of security and safety concerns regarding prisoners. Expanded testing of the P2P product will optimize the scalable unit for broader dissemination, establish the effectiveness of the training, provide critical insights relevant to dissemination of the commercial product, and position the research team to study broad dissemination and implementation outcomes.

This research was funded by a Small Business Technology Transfer (STTR) grant to KB from the National Institute on Aging at the National Institutes of Health (AG057239; Dr. Susan Loeb, Principal Investigator) and Dr. Valerie Myers, Co-Investigator. Additional collaborators on the work presented at the conference include Dr. Erin Kitt-Lewis and Dr. Rachel Wion from the Penn State University College of Nursing, and Tiffany Jerrod and Morgan Carter from KB. The technology is being developed by the KB Creative Team.

Cost Analysis of a Sun Safety Program at California Elementary Schools

Cost Analysis of a Sun Safety Program at California Elementary Schools

The Surgeon General’s 2014 Call to Action to Prevent Skin Cancer emphasized the importance of sun safety for schools. However, limited cost data exist to inform implementation decisions regarding school sun safety practices. In response, Dr. Richard Meenan from the Kaiser Permanente Center for Health Research (KPCHR), presented data on the costs of delivering a sun protection policy intervention to public elementary schools in California at the 11th Annual Conference on the Science of Dissemination and Implementation in Health in Washington DC, December 3-5, 2018.

The Sun Safe Schools (SSS) program, a joint research effort of Claremont Graduate University (CGU), KPCHR, and Klein Buendel (KB), provided technical assistance to California public elementary schools interested in implementing sun safety practices consistent with their district board policy for sun safety. The research design included a randomized trial of SSS that assessed its effectiveness in promoting implementation and an economic evaluation of the SSS program.

Fifty-eight intervention schools and 60 controls participated. Principals at intervention schools received regular phone and email contact from trained SSS coaches over 20 months to support implementation of selected sun safety practices. Rolling recruitment and intervention occurred over 47 months (2014-18). Study outcome data are from a posttest survey of school principals. Intervention delivery costs were virtually all labor (SSS coach and principal time). Implemented practices were organized into ten categories (such as student education and outdoor shade) and micro-costed using a project-developed template. Required school labor and non-labor resources for implementation were estimated for each practice. Three elementary school principal consultants reviewed the template for appropriateness.

Intervention delivery costs and costs of implemented practices for intervention schools and control schools were presented and are being submitted for publication. Principals’ beliefs about the importance of sun protection were positively correlated with policy implementation, both in numbers of implemented policies and overall dollars invested. Results indicated that a low-cost program of regular phone and email coaching of school administrators can successfully stimulate implementation of sun safety practices in elementary schools at a reasonable cost. Costs per student were similar to other school health practices. These findings can assist administrators with selecting and implementing appropriate sun safety practices for their schools.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (HD074416; Dr. Kim Reynolds, Claremont Graduate University, Principal Investigator). Collaborators in addition to Dr. Reynolds and Dr. Meenan include Kim Massie from Claremont Graduate University in California; Dr. David Buller, Julia Berteletti, and Mary Buller from Klein Buendel; and Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California.