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Dissemination & Implementation Conference

Dissemination & Implementation Conference

Three occupational sun safety projects were presented by collaborating researchers from Klein Buendel and Emory University at the 16th Annual Conference on the Science of Dissemination and Implementation in Health held December 10-13, 2023, in Washington, DC. Each presentation complemented the conference theme of “Raising Expectations for Dissemination & Implementation Science: Challenges and Opportunities,” by approaching occupational skin cancer prevention in a unique and challenging way.  

Poster 1 

Title: Differences in Program Implementation and Sun Protection of an Occupational Sun Safety Intervention: Comparison of Two Dissemination Strategies 

Presenter: Dr. David Buller, Klein Buendel 

Dr. David Buller

Balancing effectiveness and cost is essential when scaling up evidence-based interventions. In this study, two methods for disseminating an evidence-based occupational sun protection intervention that differed in cost and personal contact were compared. Solar ultraviolet radiation is a carcinogen associated with skin cancer. 

Sun Safe Workplaces (SSW), a policy and education intervention, was effective in a randomized trial in Colorado (1,2). Two methods for disseminating SSW were compared in a randomized pretest-posttest two-group trial design. State departments of transportation (DOTs; n=21) participated and the 136 districts within these DOTs were randomly assigned to receive SSW either by an in-person coaching method or a virtual coaching method. In each district, managers were pretested prior to randomization (n=1,484) and posttested (n=289) after 29-40 months (timing and attrition were affected by the COVID pandemic) on implementation of SSW training and communication and personal sun protection practices. Employees (n=1,388) also were posttested on training and communication implementation and personal sun protection practices. 

There was no difference in managers’ reported implementation of sun protection actions at the workplace between dissemination methods. But more employees reported receiving sun protection training in in-person (60%) than virtual (46%) dissemination method and being more favorable toward this training (in-person M=3.70, virtual M=3.60.) Managers at workplaces receiving SSW via in-person dissemination experienced fewer sunburns in the past year while working outdoors than with virtual program delivery (M=0.69 v. M=1.58 sunburns; estimate=-0.875, p<0.011), especially at workplaces receiving it before the pandemic compared to later in the pandemic (in-person=0.43, virtual=0.79). 

Effectiveness of evidence-based programs when scaled-up may be affected by the method of dissemination. Here, in-person coaching may have increased implementation of SSW training. It also may have aided coaches in convincing managers that there was a need for occupational sun safety and motivated them to avoid sunburn themselves and work to make employees see the value in training. The virtual delivery method may not have affected employees’ personal protection because they had limited contact with the coaches. Pandemic restrictions may have reduced intervention success. 

This research was supported by a grant (CA210259; Dr. David Buller, PI) from the National Cancer Institute at the National Institutes of Health. Coauthors on this poster presentation included Ms. Julia Berteletti and Ms. Mary Buller from Klein Buendel; Dr. Kimberly Henry from Colorado State University; Dr. Richard Meenan from Kaiser Permanente, and Dr. Gary Cutter from the University of Alabama. 

References 

  1. Buller, D. B., Walkosz, B. J., Buller, M. K., Wallis, A., Andersen, P. A., Scott, M. D., Eye, R., Liu, X., & Cutter, G. R. (2018). Results of a randomized trial on an intervention promoting adoption of occupational sun protection policies. American Journal of Health Promotion, 32, 1042-1053. 
  2. Walkosz, B. J., Buller, D. B., Buller, M. K., Wallis, A., Meenan, R., Cutter, G., Andersen, P. A., & Scott, M. D. (2018). Sun safe workplaces: Effect of an occupational skin cancer prevention program on employee sun safety practices. Journal of Occupational and Environmental Medicine, 60, 900-997. 

Presentation 1 

Title: Adaptation of an Evidence-based Occupational Sun Safety Program for Underserved Outdoor Workers in Southwest Georgia

Presenter: Dr. Alex Morshed, Emory University 

Dr. David Buller, Ms. Mary Buller, Dr. Alex Morshed, Dr. Cam Escoffery

African American and Hispanic workers face unique skin cancer risks from UV exposure and are underrepresented in occupational sun safety research. This presentation reported on adaptation of an existing evidence-based sun safety program—Go Sun Smart at Work—to predominantly African American and Hispanic outdoor workers in local government employers in Southwest Georgia. The adaptation is renamed Go Sun Smart Georgia.

The systematic adaptation process was informed by Dr. Cam Escoffery’s Key Adaptation Steps (1), Implementation Research Logic Model (IRLM) (2), and the Framework for Reporting Adaptations and Modifications (3). The original intervention promotes workplace policy and education to improve sun protection and was effective in a randomized trial in Colorado (4,5). The team mapped the program and delivery using IRLM and developed an adaptation tracking tool based on Rabin et al. (6) to catalogue and make decisions about potential adaptations. The team integrated multiple sources of information to identify compatible and feasible adaptations: consultation with program experts and community partners, qualitative data collection with outdoor workers and managers at two local government employers (Jul-Sep 2023), and synthesis of literature. 

The intervention includes training of peer coaches; written audit of employer sun safety policies, practices; employee training; and resource website (for example: training, sample policies, print materials, videos). In a pilot study with two local government employers, 11 employees identified by senior managers completed virtual 30-minute instruction to be peer coaches. Peer coaches delivered the sun safety training at staff meetings (21-39 employees per session). Several promising adaptations were identified, including modification of educational materials to better represent the worker population, addressing misconceptions, and use of external peer coaches at the workplace. Interviews with managers and focus groups with employees are in process.  

Adaptation of existing, effective interventions to better address population characteristics and needs can increase feasibility and scalability with employers throughout Georgia, which furthers dissemination and reach of existing evidence base for improving occupational sun safety and preventing cancer. 

This research was supported by a grant (U48DP006377) from the Centers for Disease Control and Prevention to the Emory University Prevention Research Center (Dr. Alex Morshed from Emory University and Dr. David Buller from Klein Buendel, MPIs). Coauthors on this oral presentation included Ms. Mary Buller, Dr. Barbara Walkosz, Ms. Irene Adjei, Mr. Brandon Herbeck, and Dr. David Buller from Klein Buendel; and Ms. Kayla Anderson, Dr. Cam Escoffery, and Radhika Agarwal from Emory University. 

References 

1.Escoffery et al. 2019. https://doi.org/10.1093/tbm/ibx067 

2.Smith et al. 2020. https://doi.org/10.1186/s13012-020-01041-8 

3.Wiltsey Stirman et al. 2019. https://doi.org/10.1186/s13012-019-0898-y 

4.Buller et al. 2017. https://doi.org/10.1177/0890117117704531 

5.Walkosz et al. 2018. https://doi.org/10.1097/JOM.0000000000001427 

6.Rabin et al. 2018. https://doi.org/10.3389%2Ffpubh.2018.00102 

Poster 2  

Title: “Technology for Workplace Implementation of Solar Radiation Safety in Response to Climate Change” 

Presenter: Ms. Mary Buller, Klein Buendel 

Ms. Mary Buller

The sun’s energy is both life-saving and life-threatening. Americans who work outdoors are exposed to rising temperatures and extreme levels of ultraviolet radiation from the sun. These exposures, without preventive measures, can cause heat illness, skin cancer, and death. It is estimated that solar radiation contributed to over 350,000 deaths from excessive heat in 2019 and over 120,000 deaths from skin cancer in 2020. The U.S. government recently launched an interagency effort to combat extreme heat, including for persons who work outdoors, and the Surgeon General has identified occupational sun safety as part of a national priority for skin cancer prevention. 

Workplace interviews, a review of literature and existing programs, and expert consultants helped increase dissemination potential by expanding an intervention for occupational skin cancer prevention to include heat illness prevention. Content consultants included safety training professionals, behavioral scientists, and dermatologists. The program, Go Sun Smart at Work, also includes messaging for outdoor workers of all skin types and risk profiles for both heat illness and skin cancer to be delivered online through workplace learning management systems to improve its dissemination. It will be evaluated in 2024 in a randomized controlled trial enrolling 20 worksites, their managers, and outdoor employees. 

A virtual learning environment (VLE) has been programmed to disseminate and guide the implementation of comprehensive sun exposure reduction to workplaces. The VLE is a web-based program with a content database, a media platform for trackable employee training (compliant with eLearning standards), and an innovative, automated decision support tool. The tool is a chat bot-like program that customizes advice on adopting workplace policy and implementing prevention procedures to management’s readiness to innovate on sun safety based on Diffusion of Innovations Theory.  

Solar radiation prevention is urgently needed to help outdoor workers adapt to a warming world. Employers have been adopting virtual training rapidly to improve accessibility, resource and learning efficiency, engagement and information retention, and fidelity and trackability. Improvements in dissemination, training, and practice, as facilitated by this VLE, can save employers time and money, improve employee health behaviors, and reduce solar-related adverse events at work.  

This research was supported by a grant (CA257778; Ms. Mary Buller, PI) from the National Cancer Institute. Coauthors on this poster presentation included Dr. Barbara Walkosz, Ms. Julia Berteletti, Mr. Brandon Herbeck, Ms. Irene Adjei, and Dr. David Buller from Klein Buendel.  

KB Investigators Present at EUSPR

KB Investigators Present at EUSPR

Three Klein Buendel Principal Investigators gave presentations on their recent or active research projects at the 14th European Society for Prevention Research Conference held October 4-6, 2023 in Sarajevo, Bosnia and Herzegovina. The presenters were Dr. David Buller, Director of Research, Dr. Barbara Walkosz, Senior Scientist, and Ms. Mary Buller, President. Each presentation complemented the conference theme of “Optimizing Prevention Infrastructures.” The prevention interventions were implemented in workplaces to reach their target populations directly and impactfully.   

Presentation 1

Dr. David Buller

“Formative Research on Professional Development Training to Maintain Responsible Beverage Service Practices”

Improved interventions are needed to reduce the negative consequences of alcohol intoxication. Responsible beverage service (RBS) training has been effective at reducing service to intoxicated customers in some cases. Its efficacy might be improved with an intervention that supports RBS techniques in the years between government-required RBS retraining. We conducted formative research to develop an ongoing professional development component for an online RBS training.

Formative research explored feasibility, acceptability, and content for an ongoing professional development intervention for alcohol servers. Semi-structured interviews were performed with owners/managers of licensed establishments (n=10) and focus groups (n=19) and survey (n=24) with alcohol servers in New Mexico and Washington. A prototype of a professional development component was produced, covering advanced RBS skills, support from experienced servers, professionalism, and basic management training, for delivery through social media. It was evaluated in a usability survey with alcohol servers (n=20) in California, New Mexico, and Washington.

While owners, managers, and alcohol servers were favorable toward RBS in their establishments, they endorsed the need for ongoing support for RBS for servers. Among topics of high interest were sharing tips, methods, and stories from experienced servers, balancing pressure to sell, navigating adult-use marijuana laws, dealing with children, recognizing intoxication, and managing difficult customers. The prototype was comprised of 50 social media posts, including text, infographics, videos, and interactive activity. Servers rated it as highly usable and appropriate for themselves and the establishment. Most servers (70%) were interested in receiving the ongoing information and activities.

Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed establishments. Servers were interested in using such program. The professional development component has the potential to improve an existing RBS intervention.

Collaborators on this presentation included Dr. David Buller and Dr. W. Gill Woodall from Klein Buendel, and Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation in California. This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA029364; W. G. Woodall and D. Buller, MPIs).

Presentation 2

Dr. Barbara Walkosz

“Sun Safety Ink!: Sun Safety Practices of Tattoo Studio Clients”

Melanoma is the second most common cancer among young adults in the United States. Sunburn prevalence and low rates of sun protection are elevated in this group. Thus, efforts are needed to promote skin cancer prevention. An estimated 225 million people worldwide have tattoos with 40% of adults ages 18-29 with at least one tattoo, and at least 30% of American have tattooed skin. Sun Safety Ink! is a skin cancer prevention program targeted to clients of tattoo studios The goal of Sun Safety Ink! is to promote full-body comprehensive sun protection to clients of tattoo studios to compliment standard aftercare instructions that recommend sun protection for new tattoos.

Thirty-seven tattoo studios were enrolled in the Sun Safety Ink! program. At pretest, clients were recruited by tattoo artists to complete an online survey that assessed current self-reported sun protection (sunscreen, lip balm, hats, protective clothing, sunglasses, and shade), number of sunburns, and sunbed tanning frequency in the last year. Respondents were also asked to locate the position of tattoos on their body, using a drawing tool. 

A total of 861 clients completed the online survey. Respondent demographics: age, average 31 yrs.; 67% female, 30% male; 60% white, 27% more than one race, 2% African American, 1% Asian and Native American, 13% Hispanic/Latino. The most prominent tattoo locations included: front left arm, 66%, front right arm, 58%, front upper torso, 52%, and back upper torso, 48%. Sun safety practices, that is, full body sun protection, (on a 5-point scale of “always” to “never”) were reported as: apply sunscreen SPF 15+ on face (aftershave, face lotion, or make-up), 3.31; apply sunscreen SPF 30+ on all exposed skin areas, 3.22; reapply sunscreen, 3.08; apply a lip balm, 3.28; wear any hat, 2.91; wear wide-brimmed hat, 2.21; wear sunglasses, 3.89; stay mostly in the shade, 3.38; and wear protective clothing, 2.91. Respondents also reported the number of sunburns as 1.53 and number of times indoor tanning as 1.11 in the last 12 months.

The pretest results indicate that full-body sun safety practices of tattooed adult can benefit from improvement, particularly wearing of hats and sun protective clothing. Further, knowledge of tattoo locations can direct sun safety recommendations to include protecting not only tattoos on arms and torsos but also non-tattooed skin on those areas of the body. Tattoo studies may be a viable location to delivering effective sun safety interventions to hard-to-reach tattooed, young adults.

Collaborators on this presentation included Dr. Barbara Walkosz, Ms. Mary Buller, and Dr. David Buller from Klein Buendel, and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the Department of Veteran Affairs. This research was supported by a grant (CA206569; B. Walkosz, PI) from the National Cancer Institute.

Presentation 3

Ms. Mary Buller

“Protection from Solar Radiation in the Era of Climate Change: Preventing Heat Illness and Skin Cancer for Outdoor Workers”

The sun’s energy is both a necessity and a threat to humans. Extreme heat linked to climate change and unprotected exposure to ultraviolet radiation (UV) make people who work outdoors vulnerable to life-threatening heat illness and skin cancer. It is estimated that infrared radiation (heat) and UV contributed to over 120,000 deaths from skin cancer in 2020 and over 350,000 deaths from excessive heat in 2019. Efforts to protect workers from heat or UV can work in tandem to help outdoor workers adapt to the warming world.

Workplace interviews, a review of literature, and expert consultants helped expand an existing intervention for U.S. occupational skin cancer prevention to include heat illness prevention, and to be delivered online. Content consultants include safety training professionals, behavioral scientists, and dermatologists. The program, Go Sun Smart at Work (GSSW), will be evaluated in 2024 in a randomized controlled trial enrolling 20 U.S. employers.

GSSW is an innovative virtual learning environment and resource hub promoting comprehensive solar radiation policy, training, and personal protection for outdoor workers. It includes (1) a manager resource hub that guides decision-makers through implementation strategies using a structured conversation agent; (2) an employee sun safety training video that is compliant with eLearning standards and compatible with learning management systems for monitoring; and (3) a trove of resources and downloadable materials addressing heat illness and skin cancer prevention. The structured conversational agent adjusts workplace implementation strategies for management’s readiness to innovate on sun safety based on Diffusion of Innovations Theory.

GSSW will help outdoor workers protect themselves from the serious threats of climate change by providing employers with a convenient, comprehensive solar radiation safety policy and training program. It will support the shift to online training to improve accessibility, fidelity, adherence, and tracking, while saving resources.

Collaborators on this presentation included Ms. Mary Buller, Dr. Barbara Walkosz, Ms. Julia Berteletti, Mr. Brandon Herbeck, Ms. Irene Adjei, and Dr. David Buller from Klein Buendel. This research was supported by a grant (CA257778; M. Buller, PI) from the National Cancer Institute.

Custody & Caring Conference

Custody & Caring Conference

A research team from Penn State University and Klein Buendel gave three presentations on their recent work related to the care of persons aging and dying in prison at the 18th Biennial International Conference on the Nurse’s Role in the Criminal Justice System. The Custody & Caring Conference was held in Saskatoon, SK, Canada on September 20-23, 2023.

Podium Presentation and Poster 1

“Small-Scale Usability Testing: E-learning Modules for Peer Caregivers”

Growing numbers of people globally will grow old and die while incarcerated. Research evidence supports using peer caregivers to assist staff with geriatric and end-of-life care. Currently, peer caregiver training varies widely in content and duration. Evidenced-based, accessible, and contextually relevant materials are needed to effectively prepare the caregivers. This study’s purpose was to conduct research and development of Just Care, a six-module e-learning program for peer caregivers and a single module to guide corrections staff in implementing the program. University IRB, U.S. Department of Health & Human Services, and Department of Corrections permissions were obtained, and participants signed informed consent. Deputy Wardens assisted in identifying people meeting our inclusion criteria. Nineteen people living in prison and 11 staff took part in the usability testing of the progam. Researchers directed participants to share their thoughts aloud. Field notes were taken. Participants completed six open-ended questions and the System Usability Scale (SUS).

Findings focused on functionality, design, and content of Just Care. All users easily navigated through the program with minimal guidance. Many noted Just Care’s utility for future peer caregivers. Challenges faced were clustered by level of severity from 1-3 (1=most; 3=least severe). There were no severity-level 1 issues in either round. In Round 1, Just Care received a SUS score of 87.5 by incarcerated users and 74.5 by staff. A SUS score of 68 is an above average score. Following rapid refinement, Round 2 incarcerated participants scored Just Care at 85.28 while staff scored it at 83.75. Some incarcerated users had difficulty navigating the post-test assessments in Round 2. A few staff users noted liking the additional resources available via links to PDFs. One staff user voiced concern about the safety of having incarcerated people help with care. Overall, participants found Just Care easy to navigate with interactive content that is very useful, engaging, and relevant to providing geriatric and end-of-life care in prisons. Staff also noted that Just Care raised awareness about the growing need for programming on geriatric care in prisons and that a peer caregiver program like Just Care is a viable solution that is implementable by prison staff.  

Poster 2

“Determining Priority Dementia Care Training Needs for Correctional Staff and Peer Caregivers”

People aged 50 and older in prisons are at particular risk for developing Alzheimer’s Disease and Related Dementias (ADRD) due to several social determinants of health. The number of patients in prison with ADRD is not known. This situation can likely be attributed to many corrections health, social, and security staff lacking the requisite skills for identifying ADRD. Dementia care inequities between prisons and community settings need to be addressed. A standardized, feasible, and acceptable ADRD education program developed for those caring for and/or managing people who are incarcerated and living with ADRD is a pressing need.

The key purpose of the research was to identify three priority learning needs of multidisciplinary prison staff to provide enhanced management and care for people living with ADRD in prisons which also represented the critical learning needs of peer caregivers so that they may assist staff with ADRD care. The study also sought to identify a logo to brand the new Just Care for Dementia training. The third outcome was to translate best practices from community-based ADRD care into accessible and relevant content for training staff and peer caregivers that is evidence-based and can be programmed into highly interactive prototype e-learning modules that fit within the restrictive context of corrections. Focus group methodology facilitated potential future users input to aid us in ensuring the content, design, and technology plans match the needs and constraints of prison. Approvals were secured from the: Institutional Review Board; federal government; and Department of Corrections. Participants provided signed informed consent. The settings were one men’s and one women’s state prison in the United States. Twelve interdisciplinary staff and 11 peer caregivers participated.

Thematic analyses revealed three priority content areas: fostering a safe and calm environment; addressing behavioral and psychological symptoms of dementia; and enhancing awareness of need. Insights on nine showcased logos revealed two clear preferences. Consultation with the study’s advisory board informed final logo selection for branding the Just Care for Dementia e-learning product. In conclusion, participants confirmed the need for a such a training program and indicated this is a viable approach to addressing a pressing training and related care need in prisons.

This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging [AG057239; Dr. Susan Loeb (Penn State) and Dr. Barbara Walkosz (Klein Buendel), Multiple Principal Investigators]. Collaborators on the presentation and posters also included Dr. Erin Kitt-Lewis, Mr. Sherif Olanrewaju, and Ms. Katherine Aiken from The Penn State University; and Mr. Brandon Herbeck, Ms. Amanda Brice, and Mr. Steve Fullmer from Klein Buendel.  

Social Media IN-SERVICE TRAINING for Responsible Alcohol Serving

Social Media IN-SERVICE TRAINING for Responsible Alcohol Serving

Among prevention strategies for driving while intoxicated (DWI), responsible beverage service (RBS) training has been effective in some cases. A research team from Klein Buendel and the Pacific Institute for Research and Evaluation (PIRE) reported on the results of a pilot project to create an in-service professional development social media component for the online evidence-based RBS training, WayToServe®, at the 46th Annual Research Society on Alcohol Scientific Meeting held in Bellevue, Washington on June 24-28, 2023.

In-service support beyond initial RBS training may counter management disinterest or resistance to RBS. A prototype of the WayToServe Plus in-service professional development social media component was produced by the authors. It contained 51 social media posts on advanced RBS skills training (such as home delivery), experienced servers supporting new servers (such as tips and tricks), professionalism (such as handling disruptive customer), and basic management procedures (such as house policies). Messages were intended to (a) increase confidence and motivation to implement RBS methods, (b) create a professional community of servers supporting RBS actions, and (c) prevent degradation of RBS skills and motivation. Thirty-six (36) posts contained text, graphics, and/or links, 14 had TikTok-style videos, and one presented an interactive learning activity from the WayToServe training.

One hundred eleven (111) alcohol servers who completed WayToServe training in New Mexico or Washington State participated in a 4-week pilot test. Participants were enrolled in either a Facebook private group with the WayToServe Plus feed and online posttest survey (n=60 servers) or in a control group with the posttest survey only (n=51 servers). WayToServe Plus posts were posted once a day, Monday to Friday. All servers in the WayToServe Plus group (100%) followed the feed for all 4 weeks; 83.3% viewed a post; and 46.7% reacted/commented on a post. WayToServe Plus servers expressed increased self-efficacy for RBS practices and response efficacy for RBS reducing DWI compared to control servers. Servers felt WayToServe Plus was appropriate and usable, and 77.9% were likely to use it in the future.

In-service professional development delivered over social media is feasible with alcohol servers and has the potential to maintain and support RBS techniques during intervals between state-approved RBS training.

This research was supported by a grant to Klein Buendel from the National Institute on Alcohol Abuse and Alcoholism (AA029364; W. Gill Woodall and David Buller, Multiple Principal Investigators). Additional authors on the conference poster include Dr. Robert Saltz from the PIRE Prevention Research Center in Berkley, California, and Ms. Lila Martinez from Klein Buendel.

B-SMART: RESULTS OF A WEB APP FOR DWI OFFENDER FAMILIES

B-SMART: RESULTS OF A WEB APP FOR DWI OFFENDER FAMILIES

Driving while intoxicated (DWI) remains a preventable source of morbidity and mortality in the United States. The Ignition Interlock Device (IID) requires a driver to blow into a breathalyzer installed in a vehicle to establish sobriety and reduces drunk driving while installed. The use of IIDs has become widespread. Most states now require DWI offenders to install IIDs in their cars. 

However, once IIDs are removed, DWI recidivism levels return to those similar to offenders who had no IID installed. The B-SMART app has been systematically developed for DWI offenders and their Concerned Family Members (CFMs) to extend non-intoxicated driving beyond the IID installation period. 

B-SMART Module Topics

  • Life with the Interlock – orientation to Ignition Interlock Devices
  • Family processes to support changes in drinking
  • Effective communication skills for families
  • Finding family activities that do not involve alcohol 

Results of a randomized trial of the B-SMART app on a variety of alcohol consumption, IID, and family communication variables were reported by Dr. W. Gill Woodall, Klein Buendel Senior Scientist, at the 46th Annual Research Society on Alcohol Scientific Meeting held in Bellevue, Washington on June 24-28, 2023.

Study participants, who were pairs of DWI Offenders and CFMs, were randomly assigned to receive the B-SMART web app or an available IID information page from the New Mexico Department of Transportation (Usual and Customary/UC condition). Participants were assessed at baseline, 3 months, and 9 months. 

Analyses of alcohol consumption variables yielded two results on alcohol quantity frequency with available data. For average drinks per day during the last 30 days at the 3-month assessment, a near significant between groups difference was detected such that client participants in the UC group reported significantly higher drinks per day when drinking than B-SMART intervention client participants. A second alcohol consumption effect was found for reported average drinks per week, where UC participants reported increasing average weekly drinking from baseline to 3-month follow-up, while intervention participants reported no significant change in average drinks per week from baseline to 3-month follow-up. Results suggest that the B-SMART app may improve outcomes for DWI offender families.

This research was funded by the National Institute on Alcohol Abuse and Alcoholism (AA022850; Dr. W. Gill Woodall, Principal Investigator). Dr. Woodall’s scientific collaborators include Dr. Barbara McCrady and Dr. Vern Westerberg from the University of New Mexico, and Ms. Julia Berteletti, Ms. Marita Brooks, and Ms. Lila Martinez from Klein Buendel.

Changes in patients’ family communication after offer of skin cancer genetic test

Changes in patients’ family communication after offer of skin cancer genetic test

Melanoma is a serious preventable form of skin cancer. Genetic testing for skin cancer risk may help increase awareness. A team led by Dr. Jennifer Hay from the Memorial Sloan Kettering Cancer Center, and including Dr David Buller from Klein Buendel, examined how an offer for testing for the melanocortin-1 receptor gene (MC1R) may have enhanced communication surrounding skin cancer within families. The research team presented a poster of their findings at the 44th Annual Sessions and Meeting of the Society of Behavioral Medicine in Phoenix, Arizona on April 26-29, 2023.

The study examined frequency targets (which family member) and topics of family communication around skin cancer at a 3-month follow-up within a New Mexico study that randomized primary care patients (N=600; 48% Hispanic) to MC1R test invitation or usual care (Aim 1). Frequency and targets were assessed on 4-point scales (“not at all” to “a lot”) asking participants how often they talked with family and with each target. Topics were assessed by asking participants whether they discussed a series of topics with family. The impact of usual care genetic test refusal and test results (average or higher risk feedback) on frequency targets and topics of family communication was assessed using ANOVAs and Chi-Square tests (Aim 2).

Aim 1 analysis showed that at the 3-month follow-up the average frequency of overall family communication was between “a little” and “some”. The most common communication targets were spouses and children; the most common topic was sun protection. Aim 2 analysis showed no significant differences in communication frequency. However, communication targets who received high-risk feedback reported greater communication with their spouse compared to those in usual care. Lastly, the study found that certain topics of communication such as “who had skin cancer in the family” and “your own risk of getting skin cancer” were discussed more by those who had testing (both receiving average and high-risk feedback) than by those in usual care or by test refusers.

The findings provide important insight into family communication about skin cancer. The results indicate greater discussion with certain people and about certain topics when individuals had undergone genetic testing highlighting the potential role that genetic testing can play in fostering family communication. Future research could provide deeper insight into why individuals talk to certain people and about certain topics more than others as well as examine how family communication affects decision-making regarding offers for cascade genetic testing or interpretation of results.

This research was supported by a grant from the National Cancer Institute (CA181241; Dr. Jennifer Hay and Dr. Marianne Berwick, Multiple Principal Investigators). Authors in addition to Dr. Jennifer Hay include Ms. Caroline Salafia (poster presenter), Dr. Smita Banerjee, and Ms. Elizabeth Schofield from the Memorial Sloan Kettering Cancer Center; Dr. Andrew Sussman, Dr. Dolores Guest, and Dr. Keith Hunley from the University of New Mexico; Dr. Kimberly Kaphingst from the University of Utah; and Dr. David Buller from Klein Buendel.

Physical Activity Research with Apps and Wearable Trackers

Physical Activity Research with Apps and Wearable Trackers

Klein Buendel Scientist, Dr. Kayla Nuss, was a presenter or co-author on four panels, posters, and presentations at the 44th Annual Sessions and Meeting of the Society of Behavioral Medicine in Phoenix, Arizona on April 26-29, 2023. The presentations highlighted research Dr. Nuss conducted as a Post-doctoral Fellow at the University of Victoria in Canada before joining Klein Buendel as a Scientist in 2022.

Dr. Kayla Nuss at SBM

Presentation 1: Poster Session

“Examining the Effect of Daily Social Media Use of Physical Activity Behaviors: A Daily Diary Study”

Presenters: Ms. Rebecca Coulter, Dr. Sam Liu, and Dr. Kayla Nuss

Previous studies have assessed the effects of health-related social media use on physical activity; however the evidence remains mixed. Currently, little is known about how daily social media use influences daily physical activity behavior. Understanding the influence of social media use on physical activity behavior may help design future interventions. The objective of this study was to examine whether the daily consumption of health-related social media content is associated with daily physical activity behaviors. Results provided evidence that viewing health-related social media content can influence daily physical activity behavior – specifically , exercise intensity. The authors suggested that future studies should focus on within-person variations in behavior based on social media use.

Presentation 2: Symposium 1

“Contextual and Situational Motivation for Physical Activity in Wearable Activity Tracker Users: A Daily Diary Study”

Presenters: Ms. Rebecca Coulter, Dr. Sam Liu, and Dr. Kayla Nuss

Wearable activity trackers (WAT) were developed to support physical activity engagement but little is known about how WAT users are motivated for physical activity. The presenters have identified distinct motivational profiles among WAT users; but no study has assessed the relationship between contextual and situational motivation for physical activity. To evaluate this relationship, intensive daily survey methodology is needed. Understanding the relationship between contextual and situational motivation for physical activity is critical to improve the effectiveness of WAT. The objectives of the study were to: (1) evaluate the feasibility of collecting day-level situational motivation for physical activity using a customized mobile app made by a no-code app development platform; and 2) describe two levels of motivation (contextual and situational) in WAT users using the hierarchical model of motivation. The presenters hypothesized that they would identify distinct motivational profiles and that those profiles would predict differing levels of situational motivation. Collecting situational motivation for physical activity was feasible using a no-code mobile platform. WAT users vary in their contextual motivational profile for physical activity and these predict some types of situational motivation. They suggested that future research should further investigate physical activity motivation in WAT users to identify intervention opportunities. 

Presentation 3: Symposium 2

“Implementing Mobile Health Interventions and Observational Studies Using a No-code App Development Platform”

Presenters: Dr. Denver Brown, Dr. Sam Liu, Dr. Kayla Nuss, and Ms. Amanda Willms

Mobile health (mHealth) technology holds tremendous potential to deliver behavior health interventions and understand human behavior. However, a challenge facing researchers when conducting mHealth research is the resources required to develop and maintain mHealth apps. Specifically, a no-code mHealth research app development platform may enable researchers with no previous software programming skills to create apps through a graphical user interface. In this symposium, presenters discussed how a no-code app development platform, was created and used to co-design and implement physical activity mHealth interventions and conduct longitudinal observational studies to understand physical activity behavior. The first presenter provided an overview of the no-code mHealth research platform and discussed its development and usability testing. The second presenter discussed how the platform was used to co-design adaptive mHealth physical activity interventions. Dr. Nuss discussed how the platform was used to implement a daily diary study to examine changes in situational motivation for physical activity based on contextual motivational profile in current wearable activity tracker users over a 14-day period. The final presenter discussed how the platform was used conduct a longitudinal feasibility study examining the influence that first-year roommates have on one another’s device-measured physical activity behavior during the transition to university which included weekly surveys to capture dyadic relations.

Presentation 4: Paper Session

“Reflecting on Physical Activity across Two Years of the COVID-19 Pandemic: Predictors if Intention-Behavior Profiles”

Presenter: Dr. Ryan Rhodes

Co-authors: Dr. Sam Liu, Dr. Kayla Nuss, and Dr. Wuyou Sui

The COVD-19 Pandemic has affected how many people engage in regular moderate-to-vigorous intensity physical activity (MVPA). Understanding the correlates of various motivational and behavioral profiles is important to producing effective interventions. The purpose of this study was to predict current and dynamic (across two years of the COVID-19 Pandemic) intention and MVPA profiles using the multi-process action control (M-PAC) framework. Few participants increased MVPA across the pandemic and dynamic patterns of intention-MVPA profiles by pre-pandemic MVPA showed the presence of two at risk groups (relapsed non-intenders relapsed unsuccessful intenders) who have relapsed in MVPA. Collectively, the findings support the joint promotion of reflective regulatory and reflexive processes in the choice of behavior change techniques to promote post-pandemic MVPA intention and behavior. 

Stringency of State Indoor Tanning Laws

Stringency of State Indoor Tanning Laws

Approximately five million cases of skin cancer are diagnosed among Americans at a cost nearing $9 billion annually. Indoor tanning (IT) is a risk factor for skin cancer. Restricting IT facilities, especially access by minors, has been the subject of state laws. More stringent restrictions on youth access (for example, bans by age vs. parental consent laws) appear to be associated with reduced IT by youth.

Julia Berteletti and David Buller at SBM

A team led by Dr. Carolyn Heckman from Rutgers University and Dr. David Buller from Klein presented a poster characterizing the IT policy landscape of U.S. states at the 44th Annual Sessions and Meeting of the Society of Behavioral Medicine in Phoenix, Arizona on April 26-29, 2023. The poster was entitled “Comparison of the stringency of indoor tanning bills regarding minors that passed and failed in state legislatures over the last 30 years.”

The research team coded 107 state IT law documents and compared passed laws to failed bills (proposed but not voted on or proposed but voted down), using a validated coding tool that assessed the presence of age bans, parental consent/accompaniment, warnings, operator requirements, and enforcement. Component codes were scaled on 10-point stringency measures (0=no regulation, 10=very strong regulation). Component and total summed scores were calculated, with higher scores indicating more stringent IT restrictions.

Between 1991 and 2022, 46 states and the District of Columbia passed a law on IT, with 23 banning access to IT facilities by minors under age 18. By contrast, 60 bills on IT failed to pass in 31 states since 2008. However, stringency of laws is weak, overall, which may explain why recent research found low compliance of IT facilities with regulations and continued IT among minors. Failed bills without minor bans were less stringent than similar passed laws, on nearly all components. Failure may have presented advocates opportunities to improve stringency of subsequent bills and time to garner more support for IT restrictions. In fact, less stringent bills may have failed because they had less support from outside constituencies (for example, medical societies and public health advocates) and among legislators. To gain insight into this public health legislation process, we are interviewing key informants from states with recent policy activity.

This research was supported by a grant to Rutgers University from the National Cancer Institute (CA244370; Dr. Carolyn Heckman and Dr. David Buller, Multiple Principal Investigators). Co-authors included Ms. Julia Berteletti from Klein Buendel and Ms. Anna Mitarotondo from Rutgers University.

Usability Testing of Just Care Modules in Prisons

Usability Testing of Just Care Modules in Prisons

Prison population demographics are shifting such that many people will grow old and spend their final days in prison. Research evidence supports using peer caregivers to assist prison staff with providing supportive care. However, the training received by peer caregivers varies widely. Evidenced-based, accessible, and contextually relevant learning materials are needed to effectively prepare peer caregivers for their role.

A research team from The Penn State University Ross and Carol Nese College of Nursing and Klein Buendel have developed Just Care, a six-module e-learning program designed to augment the face-to-face training that is typically provided to peer caregivers. Small-scale usability testing of the Just Care program was conducted with twenty men and women, who are incarcerated, and ten staff members at one men’s and one women’s state prison in a southeastern state. Two rounds of usability tests were conducted via a video-conferencing platform. The results of the usability tests were recently presented at the annual conference of Academic Consortium on Criminal Justice Health (ACCJH) in Raleigh, North Carolina on April 13-14, 2023.

Most users, who were incarcerated, did activities without aid and no tasks or programming issues were identified that made it impossible to use the application as intended. However, a few usability and content issues were noted including: (a) some users did find the x-ray scanner activity challenging when trying to drag the scanner across the body image to reveal symptoms as death approaches; and (b) a few staff users noted that the returning citizens’ video testimonials in the Staff Module lacked racial diversity.​

The System Usability (SUS) scores for each round respectively were 87.5 (incarcerated), 74.5 (staff); and 85.28 (incarcerated), 83.75 (staff). A SUS score of 68 is considered above average. Overall, both participant groups found Just Care easy to navigate with content that is interactive, useful, engaging, and relevant. Prison staff noted that Just Care raised awareness about peer caregivers’ need for training to help care for older people in prisons.

Next steps for the research team is to address the issues raised in the usability tests and prepare for large-scale usability testing to be conducted in state prisons in the summer and fall of 2023. This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging [AG057239; Dr. Susan Loeb (Penn State) and Dr. Barbara Walkosz (Klein Buendel), Multiple Principal Investigators]. Collaborators on the ACCJH poster presentation also included Dr. Erin Kitt-Lewis, Mr. Sherif Olanrewaju, and Ms. Katherine Aiken from The Penn State University; and Ms. Amanda Brice and Mr. Steve Fullmer from Klein Buendel. 

Scaling Media Literacy in a School District Environment

Scaling Media Literacy in a School District Environment

Implementation science, the study of methods and strategies that facilitate the uptake of evidence-based practices, is emerging as a framework to study the application of media literacy. Implementation science emerged in the public health field, and is just becoming known and applied in media literacy programs.

A research team led by Dr. Tessa Jolls from the Center for Media Literacy in California, and including Dr. Barbara Walkosz from Klein Buendel, conducted a panel discussion at the Global Media Education Summit held March 2-4, 2023 at Simon Fraser University in Vancouver, Canada. The panel was entitled, “Implementation Science: The Road to Scaling in a District Environment.” Two additional panelists included Dr. Marilyn Cohen from the University of Washington and Ms. Heather Van Benthuysen from the Chicago Public Schools.

The research team discussed the rising field of implementation science and presented an example underway in a U.S. school district. Relying on theories of change and rigorous evaluations of programming that exemplify these theories of change, the panelists described how implementation science provides a solid foundation for dissemination, scaling, and helping media literacy take its rightful place as a central educational offering. The panelists illustrated how implementation science works to strengthen and sustain media literacy in schools.

The Global Media Education Summit is convened by the UK’s Centre for Excellence in Media Practice, in collaboration with a leading media education space, in a different country each year. In 2023, the School of Communication and the Community Engaged Research Initiative at Simon Fraser University hosted the event, in partnership with the McLuhan Foundation. The Global Media Education Summit brings together an international network of researchers, educators, and practitioners across all aspects of media education, media and digital literacies, youth media production and media and technology in education. As the leading global showcase for research, pedagogy, and innovation, the Summit explores the changing currents across media education and media literacy communities around the world.