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Sun Safety Communication and Behavior for Students in a School Policy Intervention

Sun Safety Communication and Behavior for Students in a School Policy Intervention

In a recent publication in the Australian and New Zealand Journal of Public Health, Klein Buendel researchers and collaborators evaluated the Sun Safe Schools policy implementation intervention program in California school districts.

The United States has a high occurrence of skin cancer which has created a call to action for many organizations. The Sun Safe Schools program was created to help prevent skin cancer and to protect the nation’s youth by encouraging healthy sun safety habits for young students. In schools specifically, “children receive substantial solar ultraviolet radiation (UV) exposure, including while at school (1), and are frequently sunburned (2).”

In the study, primary schools who had existing sun safety policies were randomized into intervention and control groups and a posttest was distributed to parents. With parents in the intervention schools receiving more information about sun safety, their students on average were more likely to wear sun-protective clothing outside of school more frequently than the students of parents in the control schools. Parents in the intervention group also reported less sunburns and less time outdoors among children whose schools had implemented sun safety practices. A full description of the methods, analyses, results, conclusions, and limitations can be found in the publication.

Overall, support and implementation for a sun protection policy in school districts increased the amount of sun safety information to parents and increased the effectiveness of sun safety behaviors for children. However, experienced faculty and engaging parents are both important factors in the prevention of student skin cancer.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds and Dr. David Buller, Multiple Principal Investigators). Other authors include Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Kim Massie previously from Claremont Graduate University; and Mary Buller and Julia Berteletti from Klein Buendel.

References

1. Buller DB, Borland R. Skin cancer prevention for children: a critical review. Health Educ Behav. 1999;26(3):317-43.

2. Buller DB, Cokkinides V, Hall HI, Hartman AM, Saraiya M, Miller E, et al. Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: systematic review from national surveys. J Am Acad Dermatol. 2011;65(5 Suppl 1):114-23.

Supporting Implementation of Sun Safety Policies in Schools

Supporting Implementation of Sun Safety Policies in Schools

Many schools in California are working to increase sun protection practices by students, parents, teachers, and staff in an effort to reduce over-exposure to ultraviolet radiation and prevent skin cancer in the long term. A paper published recently in Preventive Medicine presents the results of a large randomized trial assessing an intervention designed to close a sun safety policy-practice gap in California elementary schools. The trial tested the hypothesis that schools with sun safety policies randomly assigned to receive the Sun Safe Schools intervention would implement more sun safety practices than schools in a minimal information control group.

Research collaborators from Claremont Graduate University, Klein Buendel, the Kaiser Permanente Center for Health Research, and Sun Safety for Kids, Inc. implemented the Sun Safe Schools program in 118 elementary schools from 40 California public school districts. Each school district had a school board-approved policy for sun safety (Board Policy 5141.7). The 20-month intervention was delivered to principals and included a coaching session, telephone and email contacts, resources for implementing sun protection practices, and a small grant program (for example, to purchase sunscreen for students).

The Sun Safe Schools intervention was effective at narrowing the sun safety policy-practice gap in participating California elementary schools. The program increased the total number of sun safety practices implemented by intervention schools compared to control schools. Also, more intervention schools’ sun safety practices reflected elements of district policy and sometimes went beyond the elements included in district policy. Detailed descriptions of the sample, measures, methods, analyses, outcomes, strengths, and limitations of the randomized controlled trial can be found in the Preventive Medicine publication.

The research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds, Claremont Graduate University, and Dr. David Buller, Multiple Principal Investigators). Coauthors, in addition to Dr. Reynolds and Dr. Buller, include Kim Massie formerly from CGU; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; and Julia Berteletti and Mary Buller from Klein Buendel.

Gaining Entry to Correctional Settings for Health Research

Gaining Entry to Correctional Settings for Health Research

In a recent publication for a special issue on Nursing Leadership in Correction in the journal Nursing Leadership, authors from Penn State University, Indiana University, King’s College, and Klein Buendel share lessons learned from implementing a large-scale health communication research project in correctional settings. The NIH-funded project developed, implemented, and evaluated computer-based learning modules to train corrections personnel in geriatric and end-of-life care for incarcerated individuals. The program, Enhancing Care for the Aged and Dying in Prison, was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health.

The lessons learned, and described in detail in the publication, include the importance of building a team of experts, “planning and punting” (such as designing a reliable communication plan and adjusting to the distinctive facets of each prison), coordinating with institutional review boards to protect vulnerable populations, and examining denied applications for access to correctional facilities in order to inform future planning. According to the authors, “These lessons serve to establish best practices on how to access correctional settings and to enable more research in corrections.” Access to even one correctional facility can help researchers learn more about and help to improve healthcare for people who are incarcerated.

This research was funded by a Phase I and II STTR grant from the National Institute on Aging (AG049570). The Phase I Multiple Principal Investigators were Dr. Janice Penrod and Dr. Susan Loeb from Penn State University. The Phase II Multiple Principal Investigators were Dr. Susan Loeb and Dr. Valerie Myers from Penn State University and Klein Buendel, respectively.  The first author of the recent Nursing Leadership publication is Dr. Erin Kitt-Lewis from Penn State University. Her coauthors include Dr. Susan Loeb from Penn State University, Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel, Dr. Rachel Wion from Indiana University, and Dr. Julie Murphy from King’s College.

Factors Impacting Sun Protection in California Schools

Factors Impacting Sun Protection in California Schools

Findings from a school-based sun safety study, Sun Safe Schools, were published recently in the Journal of School Health. The research team from Klein Buendel, Claremont Graduate University, the Kaiser Permanente Center for Health Research, and Sun Safety for Kids examined the correlates of sun safety policy implementation in California public school districts.

In 2002, California was the first state to enact legislation governing sun protection for students. It is California Education Code Section 35183.5. In 2005, the Sun Safe Schools research team collaborated with California Schools Board Association to develop a comprehensive Sample Board Policy for sun safety (BP 5141.7) based on California law and recommendations from the U.S. Centers for Disease Control and Prevention. The study included California public school districts that had already adopted the board-approved sun safety policy.

For the study, principals and teachers completed an online survey about sun protection policies and practices. Respondents reported on the implementation of ten school practices related to BP 5141.7 and indicated which practices, if any, were implemented in their school. Years in public education, years worked in the current district, perception that parents should take action to protect children from the sun, and respondents’ personal skin types were associated with the number of practices implemented in the school.

A full description of the methods, analyses, results, conclusions, and limitations can be found in the publication. In summary, the authors concluded that policy implementation is more likely among schools with experienced faculty, when parents are seen as important partners in student skin cancer prevention, and when school principals and teachers have a personal skin type at lower risk for melanoma.

The Sun Safe Schools program was a collaborative research effort of Claremont Graduate University (CGU), the Kaiser Permanente Center for Health Research, and Klein Buendel. The research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds, CGU, and Dr. David Buller, Klein Buendel, Multiple Principal Investigators). Collaborators included Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Kim Massie previously from CGU; and Julia Berteletti, Xia (Lucia) Liu, and Mary Buller from Klein Buendel.

Economic Analysis of a School-based Sun Protection Program

Economic Analysis of a School-based Sun Protection Program

The U.S. Surgeon General and the Centers for Disease Control and Prevention have called on the nation’s schools to help prevent skin cancer by implementing sun safety practices and policies. The Sun Safe Schools program was designed by Klein Buendel researchers and collaborators in response to those calls to action. The program was implemented and evaluated with 118 public elementary schools in California school districts with formal sun safety policy. Administrators of schools randomized to the Sun Safe Schools intervention group received phone and email support for implementing school sun safety practices by trained coaches over 20 months.

A significant part of the program evaluation — an economic analysis — has been e-published ahead of print in the American Journal of Health Promotion. The lead author is Dr. Richard Meenan, a Senior Investigator and Health Economist from the Kaiser Permanente Center for Health Research in Portland, Oregon.

The publication reports the methods, analyses, results, conclusions, and limitations of the economic analysis. Sun Safe Schools program delivery costs were micro-costed and self-reported school practices were organized into ten categories that were assigned labor and non-labor costs. Across 53 intervention schools, per-student delivery costs averaged $0.69, of which $0.44 represented school administrator time. Program delivery costs, the costs of implementing sun safety practices (such as student education, parent outreach, and shade construction), and predictors of costs are detailed in the publication.

The authors conclude that a program of phone and email coaching of elementary school administrators in school districts with formal sun safety policies can stimulate implementation of sun safety practices at a reasonable cost. The results can assist school administrators with the implementation of sun safety practices.

The Sun Safe Schools program was a collaborative research effort of Claremont Graduate University (CGU), the Kaiser Permanente Center for Health Research, and Klein Buendel. The research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds, CGU, and Dr. David Buller, Klein Buendel, Multiple Principal Investigators). Other collaborators included Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Kim Massie previously from CGU; and Julia Berteletti, Xia (Lucia) Liu, and Mary Buller from Klein Buendel.

Physical Activity Intervention for Older Adults

Physical Activity Intervention for Older Adults

In a publication in the Journal of the American Geriatrics Society, Dr. Nancy Glynn from the University of Pittsburgh, Klein Buendel’s Senior Scientist Dr. Valerie Myers, and several other contributors evaluate the effectiveness of the Lifestyle Interventions and Independence for Elders (LIFE) study.

The LIFE study was a randomized controlled trial designed to compare a moderate-intensity physical activity intervention with a health education program for sedentary older persons, 65 years or older, with low physical activity who are at risk for major mobility disability. LIFE’s primary goal was to investigate whether physical activity is an effective and practical way for preventing major mobility disability in older persons, which is defined as the inability to walk 400 meters.

For the study, participants at multiple centers were asked to perform a 400-meter walk at a normal pace every six months at which various measurements were assessed and calculated including baseline fatigue, self-reported fatigue, and energy levels. The physical activity intervention incorporated lower extremity resistance exercises, balance exercises, stretching and behavioral counseling. Health education seminars were also provided with information available about health-related matters and involved various upper extremity stretching exercises.

To learn more about the physical activity intervention and if it was effective at preserving the mobility of older adults, you can view a full description of the methods, results, and discussion in the publication.

This research was funded by a grant from the National Heart, Lung, and Blood Institute and the National Institute on Aging (AG022376; Marco Pahor, MD, University of Florida, Principal Investigator). Dr. Myers is one of the paper’s 16 authors, including the Interventions and Independence for Elders Study Group.

Hispanic Tattoo Artists as Skin Cancer Prevention Influencers

Hispanic Tattoo Artists as Skin Cancer Prevention Influencers

Skin cancer is increasing in the Hispanic population and there is a public health need for campaigns to target this often-underrepresented population. In a recent publication in The Journal of Drugs in Dermatology (JDD), authors from the University of Colorado School of Medicine and Klein Buendel examine how Hispanic tattoo artists can serve as skin cancer prevention advocates for the Hispanic population. JDD also released a podcast with the authors about the study earlier this month.

Multiple in-depth interviews were conducted with Hispanic tattoo artists at various tattoo studios in Salt Lake City, Utah. The interviews provided insight into the artist’s skin cancer knowledge, their current sun safety recommendations to clients, and their willingness to incorporate skin cancer prevention into their future work routines.

Data analysis indicated that a most of the artists had a large percentage of Hispanic clients and repeat customers. All artists also had some level of skin cancer knowledge, though not extensive enough to provide basic sun protection tips in their regular tattoo aftercare instructions to clients (such as what specific Sun Protection Factor to use, when to reapply sunscreen, and the use of cover up clothing). Despite this, all artists were enthusiastic about providing sun safety messages on their social media pages and would be willing to partake in some level of skin cancer prevention training and education in the future.

With lengthy tattoo sessions and repeat clientele, Hispanic tattoo artists could serve as beneficial influencers in the early detection of skin cancers in the Hispanic population. Researchers concluded that by providing comprehensive full-body sun protection information to their clients through tattoo aftercare instructions, alerting clients to suspicious moles, and using social media messages, Hispanic tattoo artists could have a big impact on their clients’ skin health. The study’s complete analysis and discussion can be found in the publication.

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). Authors include Dr. Cristian Gonzalez, 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.

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.