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Just Care for Dementia in Prisons

Just Care for Dementia in Prisons

Prison systems in the United States face sharply increased demands in caring for older people living in prisons. Alzheimer’s Disease and related dementias (ADRD) are age-related diseases. Prison health, social, and security staff perceive they lack the skills and knowledge essential for identifying dementia and supporting people who are incarcerated and living with ADRDs.

A research team from Klein Buendel and The Pennsylvania State University (Penn State) are launching a new research project to address ADRD care in prisons. The project is entitled “Computer-based Learning to Enhance ADRD Care in Prison: Just Care for Dementia.” The effort is being led by Dr. Susan Loeb from the Penn State College of Nursing and is being funded by a Phase I STTR grant to Klein Buendel from the National Institute on Aging (AG078103; Dr. Susan Loeb, Principal Investigator).

The mission of Corrections is to provide care, custody, and control for incarcerated individuals. Prisons are required by law to provide adequate care for growing numbers of older people who are incarcerated—a group who are disproportionately at risk for ADRD. This Phase I feasibility project focuses on research and development of highly interactive computer-based learning modules, for prison staff and people who are incarcerated and serving as peer caregivers to promote an integrated systems approach for enhancing the care of people with ADRD in prison.

The project will transform best practices in ADRD care into media-rich, highly interactive, computer-based educational module prototypes and conduct in-person usability testing of the learning module prototypes with corrections staff and peer caregivers to evaluate the user interface, ease of use, and perceived barriers in order to refine the product and optimize implementation in prison settings.

Dr. Loeb is a Professor in the College of Nursing and the Department of Medicine at Penn State University. Her research collaborators include: Dr. Donna Fick, a Professor in the College of Nursing and the Director of the Center for Geriatric Nursing at Penn State University; and Dr. Barbara Walkosz, a Senior Scientist at Klein Buendel. The ADRD modules will be programmed by Klein Buendel’s Creative Team.

Collaborator Spotlight:
Dr. Derek Griffith

Collaborator Spotlight:
Dr. Derek Griffith

Dr. Derek Griffith is a Founding Co-Director of the Racial Justice Institute, the Founder and Director of the Center for Men’s Health Equity, a Professor of Health Systems Administration and Oncology, and a Member of the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, DC. He earned his Ph.D. from DePaul University in 2002 and completed a Post-Doctoral Fellowship at the University of North Carolina School of Public Health in 2004.

Dr. Griffith’s research focuses on strategies to improve African American men’s health, such as precision lifestyle medicine interventions to prevent and control obesity and other chronic diseases. Specifically, he studies the “links between notions of masculinity or manhood and health among men of color; the role of stress and coping processes in men’s health disparities; and how gender intersects with race, ethnicity, SES and other variables to shape men’s physical and mental health behavior and health outcomes.” 

In a current research project, Dr. Griffith is a Co-Investigator with Dr. Robert Newton from the Pennington Biomedical Research Center in Louisiana and Dr. David Buller from Klein Buendel on a study to develop and evaluate a smartphone app to increase and maintain physical activity in African American. The app is called FitBrothers and will include personalization, chronic disease health information, dietary information, competition activities, and incentives to promote and sustain physical activity. The study is being funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Minority Health and Health Disparities (MD014947; Dr. Robert Newton and Dr. David Buller, Multiple Principal Investigators).

Dr. Griffith has received research grants as the Principal Investigator from the American Cancer Society, the Robert Wood Johnson Foundation, and several institutes within the National Institutes of Health. He has authored over 140 peer-reviewed manuscripts and serves on the editorial boards of several public health and men’s health journals.

Dr. Griffith has received multiple distinguished awards and honors throughout his career, including:

  • The Tom Bruce Award from the Community-Based Public Health Caucus of the American Public Health Association in recognition of his research on eliminating health disparities that vary by race, ethnicity and gender;
  • Recognition as a Fellow of the American Academy of Health Behavior for his significant contributions to the field of health behavior research; and
  • Designation as one of 1,000 Inspiring Black Scientists in America by the Cell Mentor’s Community of Scholars. 

Evaluation of the ECAD-P Program for Prison Staff

Evaluation of the ECAD-P Program for Prison Staff

There are nearly 2.3 million people incarcerated in U.S. prisons. Many grow old there and need end-of-life care. Geriatric and end-of-life care in Corrections is not as equitable as care in the free world. The results of a study led by researchers from Penn State University and Klein Buendel were published recently in the International Journal of Prisoner Health. The research team developed and evaluated the technological delivery of geriatric training for prison staff as a novel approach to improve care and reduce disparities among those who are most vulnerable during confinement.

Evaluation of the ECAD-P computer-based learning program occurred at seven sites, including six state prisons and one prison healthcare vendor. A total of 241 staff were recruited and 173 completed posttesting. The outcomes were (a) knowledge acquisition regarding care for aging and dying incarcerated persons, and (b) attitudes, motivations and values for providing geriatric and end-of-life care. Staff improved their knowledge and affective indicators after receiving the training. ECAD-P was determined to be acceptable, feasible, and usable in Corrections.

Correctional settings face increasing pressures to better address the healthcare and management needs of aged, chronically ill, and dying incarcerated persons. ECAD-P may contribute to better preparation of Corrections staff to effectively care for these populations.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). The authors of this publication are Dr. Valerie Myers, formerly of Klein Buendel; Dr. Susan Loeb and Dr. Erin Kitt-Lewis from the Ross and Carol Nese College of Nursing at The Pennsylvania State University; and Tiffany Jerrod, formerly of Klein Buendel.

Mothers’ Reactions to a COVID-19 Prevention Facebook Group

Mothers’ Reactions to a COVID-19 Prevention Facebook Group

Social media platforms have been a tool for disseminating recommendations and updates on COVID-19. Christie Idiong from the University of Connecticut presented qualitative findings from the COVID-19 Health Chat program at the 43rd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine in Baltimore, MD, April 6-9 2022.

The COVID-19 Health Chat program was a 9-week Facebook-delivered intervention to provide mothers of teenage daughters with messages promoting non-pharmaceutical interventions and vaccines, teaching digital and media literacy, and supporting family communication around COVID-19.

After the intervention, the research team conducted semi-structured interviews with 30 mothers. Mothers were asked: 1) “What did you like the most about being in the Facebook group?”, 2) “What did you like least?”, 3) “What did you think of the information sources used?”, and 4) “How would you compare the quality of the information you received in this Facebook group relative to other sources of information you’ve encountered during the pandemic?”.

Responses to each question were double coded and summarized. When asked what they liked most about the program, the most common response was the reliable information provided, followed by interacting with group members. When asked what they liked least, the most common responses indicated they did not dislike anything about the group, disliked extreme opinions from other mothers, and lacked interest in the information. When asked about sources used in the Facebook feed, the most common responses said sources were credible and helpful, followed by not recalling the sources, and sources being biased. When asked how the information in the group compared to other sources they encountered in the pandemic, most participants responded it was about the same or better quality, followed by not remembering the content. Most participants indicated that information they received was reliable, helpful, and of similar or better quality than what they had previously encountered.

Future research is needed to understand how individuals in the general population determine a source of information is reliable and how prevention communication on other health topics can be disseminated with similar success.

This research is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Authors on this poster presentation include Dr. Sherry Pagoto, Christie Idiong, Joseph Divito, Kaylei Arcangel, and Haley Troy from the University of Connecticut; and Julia Berteletti, Dr. Barbara Walkosz, Dr. Gill Woodall, Alishia Kinsey, and Dr. David Buller from Klein Buendel.

Indoor Tanning Policy and the Impact of COVID-19 on Tanning Facilities

Indoor Tanning Policy and the Impact of COVID-19 on Tanning Facilities

Julia Berteletti from Klein Buendel presented findings from a study on U.S. indoor tanning legislation efforts related to reduced indoor tanning by minors at the 43rd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine in Baltimore, MD, April 6-9 2022.

Skin cancer is a significant and expensive public health problem, with approximately 5 million Americans treated at a cost of over $8 billion annually. Indoor tanning (IT) is a well-established cause of melanoma and keratinocyte carcinomas.

Julia Berteletti Presenting at SBM

IT is regulated in two main ways: states restricting minor access and the U.S. Food and Drug Administration (FDA) regulations to minimize harm. Since 2012, 22 states and the District of Columbia adopted IT bans for all minors, ten banned some minors by age, and 12 required parental consent/accompaniment, but six have no law, primarily due to failed legislation. Seven states proposed new legislation in 2021. Additionally, FDA regulations (e.g., protective eyewear, session duration) exist to minimize harm from IT devices.

Recent evidence suggests that more stringent laws (for example, age bans vs. parental consent laws) are associated with less youth IT. Policy enforcement provisions and compliance with policies are also essential components of effective IT policy implementation, but enforcement and compliance are currently variable and inadequate. We are currently coding 102 state IT law documents that were proposed, passed, or failed, and 4 accompanying regulatory documents, using a validated coding tool. Documents are being assessed for regulation stringency, type of ban, warnings provided, operator requirements, and enforcement provisions.

Additionally, results show that beginning in March, 2020, in addition to state-level mandates, there have been additional guidelines and restrictions for IT salons due to the COVID-19 pandemic.  From March 2020 to April 2020, 49 states and the District of Columbia required salons to close to customers and reopened between April 2020 and December 2020 with varying restrictions, such as requiring appointments for services, requiring patrons to wear masks in public areas, and increasing ventilation in salons. Enforcement of these pandemic restrictions is unclear. Restrictions likely resulted in permanent salon closures and lower IT rates in 2020 but it is unknown how IT rates will be affected long-term, especially given the option for home tanning. Additional descriptive results of the policy coding and COVID-19 restrictions will be presented.

These data will help determine whether certain bill characteristics such as stringency or enforcement requirements are associated with law passage or not or bill stringency has increased over time, and the initial impact of the pandemic on IT policies. These findings will have implications for IT behavior and, ultimately, skin cancer incidence.

This research is funded by the National Cancer Institute (CA244370; Dr. Carolyn Heckman, Rutgers University, and Dr. David Buller, Klein Buendel, Multiple Principal Investigators). Authors collaborating on this conference poster include Julia Berteletti and Allyson Montalvo from Klein Buendel; and Anna Mitarotondo from Rutgers University.

COVID-19 Social Media Feed for Mothers and Teen Daughters

COVID-19 Social Media Feed for Mothers and Teen Daughters

Social media is a key channel for information on COVID-19 from government agencies, near-peers, and news media. The Health Chat team developed a social media feed that varied type of information source in posts on social distancing, COVID-19 vaccines, digital and media literacy, and family communication. Dr. David Buller from Klein Buendel presented findings from the COVID-19 social media feed at the 43rd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine in Baltimore, MD, April 6-9 2022.

A total of 303 mothers with adolescent daughters from a previous study testing a social media campaign on indoor tanning were recruited in January 2021 and enrolled in a randomized single-factor design (government agencies v. near-peer parents v. news media) of a 9-week Facebook feed with four assessments (baseline, 3-week, 6-week, and 9-week follow-ups). The feed contained five posts per week based on social cognitive theory, transportation theory, and diffusion of innovation theory. Mothers reported on social distancing and vaccine intentions for self and daughters.

Using intention-to-treat analyses, mothers’ reports of social distancing by self and daughter declined over the 9-weeks. Daughters’ social distancing declined faster in the near-peer condition but less quickly in the government condition. Vaccine intentions increased over the nine weeks in all experimental condition. Baseline intentions seemed to moderate effect of condition on change in intentions. Mothers with initially high vaccine intentions (relative to moderate intentions) assigned to the government condition reported a less steep increase in intentions over time and had slightly lower intentions to vaccinate at the end of the study. Baseline credibility of the assigned information source predicted increased vaccine intentions. However, in the near-peer condition, mothers who assigned them lower as opposed to higher credibility showed increased vaccine intentions.

Theory-based posts emphasizing information from government agencies may have provided credible counterarguments against local jurisdictions relaxing pandemic restrictions that slowed declines in daughters’ social distancing. The near-peer sources may have been influential with mothers who did not expect them to convey the credible arguments supporting vaccines which they did in the experimental feed, consistent with violations of expectations theory in persuasive communication.

This research is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Authors on this presentation include Dr. Sherry Pagoto and Joseph Divito from the University of Connecticut; Dr. Kim Henry from Colorado State University; and Dr. David Buller, Dr. Barbara Walkosz, Dr. Gill Woodall, Julia Berteletti, and Alishia Kinsey from Klein Buendel.

Dr. David Buller Presenting at SBM
Promoting Health Equity for Diverse Populations During a Pandemic

Promoting Health Equity for Diverse Populations During a Pandemic

Dr. Susan Loeb, PhD, RN, FGSA, FAAN, from the Pennsylvania State University College of Nursing and College of Medicine – and an active Klein Buendel research collaborator – presented on promoting health equity during the COVID-19 pandemic at 34th Annual Scientific Session of the Eastern Nursing Research Society on March 31 through April 1, 2022 in Providence, Rhode Island. The theme of the conference was “Charting the Path of Diversity, Equity, and Inclusion Through Nursing Science.”

The interruption of face-to-face human subjects’ research by universities and correctional institutions due to the COVID-19 pandemic has necessitated researchers to adopt alternative approaches for proceeding with their work. Adaptations and strategies that the research team employed to keep their study progressing forward in meaningful ways despite a protracted public health emergency were presented. A study focusing on the research and development of highly interactive e-learning modules to prepare incarcerated people to assist corrections staff in caring for people are older and/or approaching the end of life in prison served as an exemplar for the presentation. The study – the Inmates Care Project – is an STTR grant awarded to Klein Buendel by the National Institute on Aging (AG057239; Dr. Susan Loeb and Dr. Barbara Walkosz, Multiple Principal Investigators).

The theoretical framework for the study is the Institute for Healthcare Improvement’s Framework for Going to Full Scale. Identification of barriers and facilitators, re-envisioning how the team would restructure their day-to-day work, and preparing for the future are just a few of the essential steps that were taken. Examples of daily restructuring included a) approach to weekly team meetings; b) data collection protocols; c) advisory board meetings; and d) opportunities for networking and community building.

Key lessons learned through this experience included the a) importance of taking stock and seizing the opportunity to make investments in team member development; b) writing protocols that detail both in-person and virtual options for data collection to allow the team to pivot quickly when the next challenge arises; and c) reaching out to brainstorm with funding agency program officers, Institutional Review Board analysts, advisory board members, and other researchers from beyond your team.

Well-thought-out adaptations that are approved by funding agencies, offices of research protections, and other stakeholders in the research can result in scientifically sound, public health safe, and pragmatic approaches for moving ahead to remain research-productive, despite public health challenges. Taken together, these approaches can maintain study progress, and scientific integrity, as well as identify alternate ways to achieve study aims in a timeline necessarily relaxed, but as close as possible to the original plan.

Co-authors on the presentation and top poster included Dr. Erin Kitt-Lewis, Sherif Olanrewaju, and Leigh Casey from Penn State University; Dr. Valerie Myers and Savanna Olivas formerly from Klein Buendel; Jeannyfer Reither from Klein Buendel; and Katherine Aiken from the Penn State College of Health and Human Development.

Risks and Protective Factors for Non-medical Prescription Drug Use among Teen Girls

Risks and Protective Factors for Non-medical Prescription Drug Use among Teen Girls

Prevention efforts can be informed by learning more about the risks and protective factors for adolescent non-medical use of prescription drugs (NMUPD). A study was conducted with data collected from the Health Chat study to look at the potential influence of maternal factors, social norms, and perceptions of risk and availability on NMUPD by adolescent females. Health Chat was a social media intervention to help reduce mothers’ permissiveness toward their teen daughters’ indoor tanning behavior in an effort to prevent skin cancer. Mother-daughter communication on other health topics was also analyzed. Methods and findings for this NMUPD analysis have been published online in the journal, Drugs: Education, Prevention and Policy.

Multiple logistic regression was used for analysis. Daughters’ past NMUPD and inclination for future NMUPD were regressed onto descriptive norms for friend use, perceived drug accessibility and risk of harm from use, daughter age, mothers’ disapproval about use, mothers’ past NMUPD and inclination for future NMUPD, and the mother-daughter relationship quality. Akaike weights and lasso regressions were also estimated to evaluate the relative importance of each correlate. Higher descriptive norms for friend use, older age, and mothers’ inclination for NMUPD were risk factors for daughters’ NMUPD. Protective factors were a closer mother-daughter relationship and mothers’ disapproving attitudes towards NMUPD. The authors conclude that friend descriptive norms, mother-daughter relationship quality, and mothers’ attitudes about NMUPD could be explored as key targets for prevention efforts.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). The lead author is Gemma Wallace from Colorado State University. Collaborating authors include Dr. Katie Baker and Dr. Stephanie Mathis from East Tennessee State University; Dr. Kimberly Henry from Colorado State University; Dr. Sherry Pagoto from the University of Connecticut; and Dr. David Buller and Julia Berteletti from Klein Buendel. 

Persisting Effects of the Health Chat Program

Persisting Effects of the Health Chat Program

The use of indoor tanning facilities by minors is a public health concern. In an effort to reduce risk for skin cancer, the Health Chat social media intervention was launched by Klein Buendel researchers and their colleagues to reduce mothers’ permissiveness toward their teenage daughters’ indoor tanning behavior.

For the Health Chat study, mothers with daughters aged 14-17 were recruited in 34 states that do not ban indoor tanning by minors. Participating mothers received an adolescent health social media campaign in Facebook private groups. Half of the mothers were in a group in which the health campaign included posts about preventing indoor tanning (intervention) and the other half, included posts on preventing prescription drug misuse (control). Follow-up surveys with mothers at 12 months and 18 months measured indoor tanning permissiveness, attitudes, intentions, communication, behavior, and support for state indoor tanning bans.

Analysis of the 18-month follow-up data from the Health Chat social media intervention was e-published recently in Cancer Epidemiology, Biomarkers & Prevention. The research was led by Dr. David Buller from Klein Buendel and Dr. Sherry Pagoto from the University of Connecticut.

The methods and results of this randomized trial are detailed in the publication. Data analysis showed that at 18 months after the intervention, mothers in the intervention group were less permissive of indoor tanning by daughters and had greater self-efficacy to refuse daughter’s indoor tanning requests than mothers in the control group. Intervention-group mothers also had lower intentions to indoor tan themselves and were more supportive of bans on indoor tanning by minors than control-group mothers. In addition, daughters in the intervention group expressed less positive attitudes toward indoor tanning than daughters in the control group.

In summary, the Health Chat social media intervention may have influenced mothers’ decisions to withhold permission for their daughters to indoor tan for six months after the end of the program. Mothers’ support for bans on indoor tanning by minors also appears to have persisted.

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

ezPreemie Project

ezPreemie Project

Today, 80-90% of very preterm infants survive. However, preterm birth alters the development of the prefrontal cortex, the brain region heavily involved in behavior regulation and inhibition. This places children born very preterm at high risk for developmental delays and behavioral problems.

Early prevention and intervention can interrupt the development of problem behaviors, reduce active problem behaviors and improve functioning for children and families. Behavioral parent training (BPT) is a gold standard for prevention and treatment of child behavior problems. BPT teaches child management skills and positive parenting strategies. Little is known about the use and effects of BPT programs for former very preterm infants with their unique medical, developmental, and psychological risk profiles.

A research team from Ohio State University, Rush University, Nationwide Children’s Hospital, and Klein Buendel is launching a 5-year research project to develop and evaluate a technology-based, widely accessible, and effective form of BPT delivery to address the unmet and unique needs of parents of very preterm children. The app will be tested alone and in combination with specialized coaching. The project is called “Parent Training for Parents of Toddlers Born Very Premature.” It is being led by Dr. Susie Breitenstein from Ohio State University (OSU) Dr. Michele Greene form Ruch University (Multiple Principal Investigators). the project funded by The Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD104072).

The research project will design and develop a web-based app, similar to one developed previously by Dr. Breitenstein and her team, called ezParent. ezParent was designed for parents of children ages 2-6. It provides behavioral training through brief vides, interactivity, reflection questions, and assessments to parents of young children. The new iteration of ezParent ezPreemie will assess the independent and combined effects of ezParent and coaching calls on parent and child outcomes in families with very preterm infants.

Dr. Breitenstein, PhD, RN, FNAP, FAAN, is an Associate Professor, Assistant Dean for Research and Innovation, and Senior Director, Community Outreach and Engagement & CHW Training Program in the OSU College of Nursing. Dr. Michelle Greene is an Associate Professor and Director of the Psychology Section in the Department of Pediatrics at Rush Medical College. Research Co-investigators include Dr. Michael Schoeny and Dr. Kousiki Patra from Ruch University, Dr. Sarah Keim and Dr. Mary Lauren Neel from Nationwide Children’s Hospital, and Ms. Julia Berteletti from Klein Buendel. The ezPreemie app will be engineered by Klein Buendel’s Creative Team.