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Project SHINE for Adolescent Tanning Prevention

Project SHINE for Adolescent Tanning Prevention

Dr. David Buller, Klein Buendel Director of Research, is a Co-Investigator on a new research project funded by the National Cancer Institute and being led by Dr. Yelena Wu, Principal Investigator, from the University of Utah. Project SHINE (Sun-safe Habits Intervention and Education) is a multi-modal intervention that targets adolescents’ views on the personal relevance of skin cancer and their ability to prevent the disease in order to increase their sun protection use and decrease their intentional tanning.

Project SHINE incorporates action plans, sun damage photographs, and education to teachers and parents in order to build on adolescents’ interest in novelty and need for highly personalized interventions. It also promotes environmental supports for adolescent skin cancer prevention. SHINE is novel in its application of the Extended Parallel Process Model, used in smoking and drug abuse interventions, to pediatric skin cancer prevention. The five-year study will be conducted with 30 high schools and over 10,000 students in 9th or 10th grade health classes. To support the rigor of this research, the project will objectively measure ultraviolet radiation (UVR) exposure among 10% of the sample who will wear a UVR monitoring device for 3-day periods after self-reported assessments.  

Dr. Buller is part of a well-established team that includes experts in skin cancer prevention, adolescent health behavior change, dermatology, school programs, and randomized trials. He will provide input on the design and implementation of the study, help develop parent/teacher education materials, and participate in results interpretation and manuscript preparation.

Skin cancer is a significant public health priority. It is the most commonly diagnosed form of cancer, afflicting more than 5 million people in the United States each year. Treatment costs total more than $8 billion each year. Skin cancer is highly preventable if individuals limit UVR exposure by using sun protection strategies, such as sunscreen, hats, protective clothing, and by avoiding tanning. Use of prevention strategies is critical during childhood and adolescence, when skin cells are particularly vulnerable to UVR damage leading to skin cancer. Due to their poor use of sun protection and likelihood to intentionally tan, adolescents, more than any other pediatric group, urgently need efficacious skin cancer preventive interventions. Schools offer the ideal setting to deliver skin cancer preventive interventions to large numbers of adolescents.

Health Chat Presentation for NCI

Health Chat Presentation for NCI

Dr. David Buller from Klein Buendel presented initial findings from an ongoing social media campaign for mothers to improve adolescent health and reduce indoor tanning, called Health Chat, via webinar to the Health Communication and Informatics Research Branch of the National Cancer Institute on December 10, 2019.

Despite the substantial risk of skin cancer from indoor tanning, it remains popular among older adolescent females aged 14-17 and mothers aged 27-45. The CDC1 and the Surgeon General2 have set a national goal of reducing indoor tanning by teens and public policies restricting indoor tanning are increasing. However, many states still allow minors to indoor tanning, with varying forms of restriction.3 

Because mothers’ permissiveness of indoor tanning and her own indoor tanning are strong predictors of adolescent daughters indoor tanning, and many daughters initiate indoor tanning with their mother, the research team developed a program aimed at moms in an effort to reduce indoor tanning by minors. A multi-faceted adolescent health and wellness campaign was created to be delivered through Facebook private groups that included messages on indoor tanning prevention, prescription drug misuse, vaccinations, healthy lifestyles, substance use, mother-daughter communication, and more. Mothers (n=869) were in the groups for one year and received messages daily. Mothers and their daughters completed surveys at baseline and 12-month follow-up, and 18-month follow-up surveys are currently underway.

Dr. Buller reported on how the Health Chat program was created, the potential of using social media for research, campaign engagement measures, and initial findings from the 12-month follow-up survey of mothers and daughters. He shared methodological challenges that arose from using Facebook private groups such as Facebook algorithms changing, the inability for participants to share content outside of the groups, and logistical barriers of adding participants to groups. He also shared plans for coding user-generated content,4 including hundreds of comments left by mothers on the Facebook posts. Full results should be published in 2020.

This research was funded by a grant to Klein Buendel from the National Cancer Institute [CA192652; Dr. David Buller and Dr. Sherry Pagoto (from the University of Connecticut), Multiple Principal Investigators]. Co-Investigators include Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University, and Dr. Kimberly Henry from Colorado State University.

References

1. Healthy People 2020 – topics & objectives. Office of Disease Prevention and Health Promotion Web site. Available at: https://www.healthypeople.gov/2020/topics-objectives. Published 2012. Accessed December 17, 2019.

2. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Surgeon General; 2014.

3. National Conference of State Legislatures. Indoor tanning restrictions for minors: A state-by-state comparison. National Conference of State Legislatures Web site. Available at: http://www.ncsl.org/research/health/indoor-tanning-restrictions.aspx. Published May 20, 2019. Accessed December 17, 2019.

4. Buller D, Walkosz B, Berteletti J, et al. Insights on HPV vaccination in the United States from mothers’ comments on Facebook posts in a randomized trial. Hum Vaccin Immunother. 2019;15(7-8):1479-1487. doi: 10.1080/21645515.2019.1581555

ID Compliance by Recreational Marijuana Stores in Two States

ID Compliance by Recreational Marijuana Stores in Two States

The recreational sale of marijuana has begun in ten U.S. states and seems likely to expand to several others. Only state-licensed stores can sell recreational marijuana products and only persons over age 21 who provide a valid state-approved identification (ID) can enter the stores and purchase marijuana. The age and ID regulations are intended to prevent youth gaining access to recreational marijuana, and it is important to investigate whether these age and ID restrictions are actually working.

Research collaborators from Klein Buendel and the Pacific Institute for Research and Evaluation, measured compliance with age and ID regulations by state-licensed recreational marijuana stores in two states and reported their findings in the Journal of Studies on Alcohol and Drugs. The paper reports assessment of sale refusal rates in a large, diverse sample of stores selling recreational marijuana in the states of Colorado and Washington. The paper’s analyses describe ID checking behavior by store personnel, estimate refusal rates, and explore factors associated with refusal. 

One hundred seventy-five recreational marijuana stores in Colorado and Washington were visited twice by pseudo-buyer assessment teams in September 2016 to April 2017. A young-adult buyer attempted to enter the store and purchase marijuana without showing a state-approved identification. In the second Colorado visit, a buyer aged 18-20 showed an underage driver’s license and attempted to enter the store and purchase marijuana. No cannabis products were actually purchased.

All stores requested an ID. Stores refused buyers in 73.6% of visits at the entrance, 88.3% cumulative before the counter, and 92.6% cumulative by the time of a purchase attempt. Refusal was lower in Washington than in Colorado but it did not differ by buyer protocol. Overall, compliance with laws restricting marijuana sales to individuals 21 or older with a valid ID was high. The authors suggest that compliance in Washington might be improved by having store personnel check IDs at the store entry. Recreational stores may not be selling marijuana directly to youth, although no information was collected on straw purchases. The measures, methods, analyses, results, conclusions, and limitations are detailed in the publication.

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). Coauthors include Dr. Gill Woodall and Ms. Mary Buller from KB, and Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation.

Preventing Alcohol and Drug Overuse Among Nightclub Patrons

Preventing Alcohol and Drug Overuse Among Nightclub Patrons

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

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

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

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

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

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

Ultraviolet Radiation and the Fading of Colored Tattoos

Ultraviolet Radiation and the Fading of Colored Tattoos

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

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

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

This project was funded by a grant and a supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Paper authors include Dr. Cristian Gonzalez, Dr. Chandler Rundle, and Dr. Adrian Pona from the University of Colorado School of Medicine; Dr. Barbara Walkosz from Klein Buendel; and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the U.S. Department of Veterans Affairs Rocky Mountain Regional VA Medical Center Dermatology Service.

Melanoma Receptor Variation in a New Mexico Population

Melanoma Receptor Variation in a New Mexico Population

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

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

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

Economic Evaluation of Adopting Occupational Sun Protection Policies

Economic Evaluation of Adopting Occupational Sun Protection Policies

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

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

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

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

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

Project STRONG Expands into Spanish

Project STRONG Expands into Spanish

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

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

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

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

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

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

References

1. Houck CD, Hadley W, Barker D, Brown LK, Hancock E, Almy B. An emotion regulation intervention to reduce risk behaviors among at-risk early adolescents. Prev Sci. 2016;17(1):71-82. doi: 10.1007/s11121-015-0597-0
2. Lundgren R, Amin A. Addressing intimate partner violence and sexual violence among adolescents: emerging evidence of effectiveness. J Adolesc Health. 2015;56(1 Suppl):S42-S50. doi: 10.1016/j.jadohealth.2014.08.012
3. National Criminal Justice Reference Service; Rizzo CJ, Houck C. Summary Report: Partner Violence Prevention for Middle-School Boys: A Dyadic Web-Based Intervention Study (Project STRONG). Available at: https://www.ncjrs.gov/pdffiles1/nij/grants/252517.pdf. Published January 2019. Accessed August 21, 2019.

Using Panel Vendors to Recruit Research Participants

Using Panel Vendors to Recruit Research Participants

It has become more common to recruit research study participants through online panel vendors, such as GfK or Qualtrics. In a publication made available recently in PubMed Central from Evaluation and the Health Professions, Dr. Meme Wang-Schweig from the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE) and her coauthors (including Dr. David Buller from Klein Buendel), report on the use of panel vendors for recruiting research participants into a randomized controlled trial. The research study was testing an online, family-based alcohol prevention program for parents and older teens, called Smart Choices 4 Teens.

Panel vendors are hired to recruit and match potential research participants to a target population for data collection.  Most panel vendors use non-probability sampling which does not involve random selection. People opt in to participate. The vendors advertise for panelists using website banner ads, emails, direct mail, etc. Panelists are paid but may also enjoy contributing their opinions to a research study. Panel vendors can recruit a potential research sample quickly.

Dr. Wang-Schweig’s paper endeavors to answer two methodological questions: (1) how well do panel vendors provide a sample of families to participate in a trial who meet specific inclusion criteria, and (2) how well do panel vendors provide a sample of families to participate in a trial who reflect the make-up of the general population? Using the Smart Choice 4 Teens project’s experience as a real-world example, the authors describe the process of working with panel vendors, the sample’s match to the intended target population, and the additional screening they employed to ensure the quality of the sample. Several recommendations are made for other research teams looking to use panel vendors to recruit study participants.

Smart Choice 4 Teens was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA020977; Dr. Brenda Miller, PIRE, Principal Investigator). Dr. Wang-Schweig’s coauthors for this publication included Dr. Brenda Miller, Dr. Hilary Byrnes, Dr. Beth Bourdeau, and Ms. Veronica Rogers from PIRE; and Dr. David Buller from Klein Buendel.

The Importance of Managers’ Awareness of Sun Protection Policy

The Importance of Managers’ Awareness of Sun Protection Policy

Improving occupational sun protection is a priority in the United States, as The Surgeon General’s Call to Action to Prevent Skin Cancer highlights. Klein Buendel and its collaborators responded to the call by launching a randomized trial to evaluate the effectiveness of a workplace sun protection program for outdoor workers. The program, Sun Safe Workplaces, was implemented with 98 public employers in Colorado, a state with high ultraviolet radiation due to its high elevation and sunny climate. The intervention promoted the adoption or strengthening of sun safety policy and the implementation of employee sun protection training. A two-year follow-up study also was completed with 68 of the 98 public sector employers.

In a recent publication in the American Journal of Industrial Medicine, Dr. Barbara Walkosz, Klein Buendel Senior Scientist, and her coauthors reported results related to the hypothesis that senior managers’ awareness of sun protection policy in the workplace would predict increased sun safety practices by employers and employees who work outdoors.

A full description of the methods (questionnaires and on-site observations), results, conclusions, and limitations of the research can be found in the American Journal of Industrial Medicine publication. In general, more sun safety messages, manager-employee communication, sun safety practices, and sun protection equipment (sunscreen, hats, etc. ) were evident when senior managers were more aware of their organization’s sun protection policy.

Overall, the authors found that occupational sun protection programs can be more effective on the “front line” (with people who work outdoors) when the “back office” (senior management) is aware of and can, therefore, support and encourage their organization’s sun safety policies and practices.

This analysis was funded by a grant from the National Cancer Institute at the National Institutes of Health (CA134705; Dr. David Buller and Dr. Barbara Walkosz, Principal Investigators). Dr. Walkosz’s coauthors on this paper included Dr. David Buller, Ms. Mary Buller, and Ms. Xia (Lucia) Liu from Klein Buendel, and Dr. Allan Wallis from the University of Colorado Denver.