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Physical Activity Maintenance in African American Men

Physical Activity Maintenance in African American Men

In a recent publication in mHealth, Dr. Robert Newton, Dr. Valerie Myers, and their coauthors describe the development of a smartphone app to help African American men maintain physical activity. The formative research was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute of Minority Health and Health Disparities.

African American men experience higher rates of morbidity and mortality from several chronic diseases that have low physical activity as a modifiable risk factor. For example, increased levels of physical activity have been shown to reduce the risk of developing obesity, cardiovascular disease, and diabetes. Yet, African American men’s levels of regular physical activity remain low.

The study set out to develop and test the feasibility of a prototype smartphone app to promote physical activity maintenance in African American men. The publication describes formative research (focus groups), user-centered design, and evaluation (usability testing and one-month beta testing) of the MobileMen app through an iterative process with participants from the target population.

MobileMen and its learning activities were designed with a Social Cognitive Theory framework. The programmed app included a dashboard, learning activities, a prompting system, an activity tracker, and rewards.

Users reported above average satisfaction with the app. They also rated the app as user-friendly, helpful, enjoyable, and culturally relevant. The participants reported willingness to use the app to improve their physical activity. Rates of app use and other data are reported in the paper. A full description of the methods, results, conclusions, strengths, and limitations of the feasibility study, as well as a discussion on the inclusion of nutrition information, can be found in the mHealth publication.

The STTR Phase I project was funded by grant number MD010304 (Dr. Robert Newton, Pennington Biomedical Research Center, Principal Investigator). Coauthors include Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel, Leah Carter and Jessica Romain from the Pennington Biomedical Research Center, and Dr. Derek Griffith from Vanderbilt University.

Prevention of Alcohol Use in Older Teens

Prevention of Alcohol Use in Older Teens

The growing incidence of alcohol use among teens is an important public health problem. In a recent publication in Psychology of Addictive Behaviors, Klein Buendel Senior Scientists, Dr. David Buller and Dr. Gill Woodall, joined multiple co-authors to report on the effects of a new alcohol use prevention program for older teenagers. The program is called Smart Choices 4 Teens. The paper reports the results from a randomized controlled trial assessing the impact of this online, interactive, family-based alcohol prevention program with over 400 families on preventing and reducing teen alcohol use.

Smart Choices 4 Teens was designed with three sequential components: general parent-teen communication, teen alcohol use, and teen romantic relationships. The creators adapted two evidence-based programs — Family Matter (1) and Parent Handbook (2) — to appeal to older teens and their parents. Communication skills training was incorporated through videos and interactive activities. The program was designed to have parents and teens go through the online activities separately and then complete a discussion activity together at the end of each component. The Alcohol Component is the focus of this publication.

Use of the program varied across families and components. Families that used more of the program reported better outcomes. Data related to dosage of the program and changes in drinking rates are reported in detail in the paper. Many positive effects were seen at 6-month and 12-month follow-ups with participating families. For example, teens in the experimental group reported fewer friends who had been drunk at six months, and parents in the experimental group reported more communication about social host laws. At 12 months, parents in the experimental group reported consuming fewer alcoholic beverages.

Overall, the findings suggest that Smart Choices 4 Teens was beneficial for families, especially when parents and teens completed more of the program. The authors believe that dissemination and implementation strategies that motivate completion of Smart Choice 4 Teens content, especially the Alcohol Component, can improve outcomes related to older teens’ alcohol use.

A full description of the methods, results, and conclusions of this study can be found in Psychology of Addictive Behaviors. This research was funded by a grant to the Prevention Research Center at the Pacific Institute for Research and Evaluation from the National Institute on Alcohol Abuse and Alcoholism (AA020977; Brenda Miller, Principal Investigator). Authors in addition to Dr. Miller, Dr. Buller, and Dr. Woodall include first author Dr. Hilary Byrnes, Dr. Joel Grube, Dr. Beth Bourdeau, and Dr. Meme Wang-Schweig from the Pacific Institute for Research and Evaluation. The Smart Choices 4 Teens program was produced by Klein Buendel’s Creative Team.

References

  1. Bauman, K. E., Foshee, V. A., Ennett, S. T., Hicks, K., & Pemberton, M. (2001). Family Matters: A family-directed program designed to prevent adolescent tobacco and alcohol use. Health Promotion Practice, 2, 81-96. http://dx.doi.org/10.1177/152483990100200112
  2. Turrisi, R., Jaccard, J., Taki, R., Dunnam, H., & Grimes, J. (2001). Examination of the short-term efficacy of a parent intervention to reduce college student drinking tendencies. Psychology of Addictive Behaviors, 15, 366–372. http://dx.doi.org/10.1037/0893-164X.15.4.366
Use of Media and Social Media in the Prevention of Substance Use

Use of Media and Social Media in the Prevention of Substance Use

Three Klein Buendel Senior Scientists have authored a chapter in a new 2019 book, Prevention of Substance Use, published by Springer. The chapter titled, “Use of Media and Social Media in the Prevention of Substance Use,” was written by Dr. David Buller, Dr. Barbara Walkosz, and Dr. W. Gill Woodall.

Mass media have changed dramatically over the past 25 years, yet still remain an important channel for substance abuse prevention messages (e.g., alcohol, tobacco, marijuana). Exposure to messaging is an important issue for campaigns. This book chapter describes how online and social media have added new media platforms for substance abuse campaigns. Overall, evaluations of web-based interventions show some promise for substance abuse prevention, although the effects appear modest. Less is known about the effectiveness of social media in substance abuse campaigns, especially the influence of user-generated content and commercial advertising.

The chapter describes several recent changes that have revolutionized the media. These include the birth of the Internet, the emergence of new media (including web-based intervention and social media) that has made content available on-demand, and the introduction of mobile computing that has vastly changed connectivity, reach, and engagement. Each of these developments raises questions (which the authors explore) about the influence of new media on substance abuse campaigns and challenges for conducting research on the effects of prevention intervention delivery. The book chapter delves into the role of audience activity, starting with audience exposure determined by selective attention, exposure, and retention, and moving on to examine user-generated content in the new media environment.

The emergence of new media holds promise for future substance abuse prevention campaigns but comes with a number of challenges that are explored in the chapter. These include (1) the fact that theories of social media impact are not well developed; (2) the development of effective methodologies to measure and assess the effects of emerging media; (3) the determination of how commercial online marketing strategies influence substance use and how social marketing approaches can use similar strategies for prevention; (4) the need to understand the use of multiple platforms for promotion (e.g., broadcast, print, online media); (5) the determination of how best to leverage and encourage user-generated media for substance abuse interventions; and (6) the need to explore the interactive nature of emerging media more fully. The authors suggest that these challenges represent tremendous opportunites to better understand and more effectively impact many different populations for the improvement of their health.

Book Citation

Z. Sloboda, R. Hingson, and H. Petras (Eds.), Prevention of substance use. New York: Springer, 2019.

Insights About HPV Vaccination in the United States from Mothers on Facebook

Insights About HPV Vaccination in the United States from Mothers on Facebook

According to the Centers for Disease Control and Prevention, the most common sexually transmitted infection is the human papillomavirus (HPV) but only about half of girls and less than 40% of boys in the United States have received all the recommended doses of the HPV vaccine (1). In a recent e-publication in Human Vaccines and Immunotherapeutics, Klein Buendel Senior Scientists, Dr. David Buller and Barbara Walkosz, and Project Manager, Julia Berteletti, and coauthors provide insights on HPV vaccination in the United States from mothers’ comments on Facebook posts in a randomized trial. The study evaluated responses from mothers of teenage girls living in various U.S. states in relation to HPV vaccine health and related information posted to private groups on Facebook.

A large number of mothers of 14-17-year-old girls joined private groups on Facebook where a variety of health information relevant to adolescent girls was posted daily. Topics included indoor tanning, mother-daughter communication, and HPV vaccinations. Posts discussing HPV vaccination were posted in each of the groups and ranged from didactic messages (e.g., the need for adolescent vaccines, how well HPV vaccines are working to decrease infection rate, number of parents choosing to vaccinate children against HPV, etc.) to narrative posts about women who have died from cervical cancer. Posts also included a link to an article, video, photograph, or an infographic.

Comments by participants were generally more favorable toward HPV vaccination than unfavorable. Mothers’ comments are further described in the journal article.

A strength of the analyses identifying participant pre-existing characteristics before posting the HPV messages on Facebook, therefore being able to show that HPV vaccination was a predictor of commenting behavior with mothers who had not vaccinated their daughters as the unfavorable commenters. It is noted that many of the mothers who did not comment had daughters that were vaccinated for HPV. A possible weakness of the study was that the sample of mothers may have limited generalizability. Authors conclude by stating that the fact that many mothers who had daughters vaccinated against HPV did not comment on the HPV posts could contribute to the idea that opposition to the HPV vaccine is larger than it is in actuality. Authors also suggest that U.S. public health agencies and practitioners need to find ways to dispel myths and provide information on vaccine safety and concerns, including that many mothers choose to vaccinate their daughters against HPV.

This research was funded by a grant to Klein Buendel from the National Cancer Institute (CA192652; Dr. David Buller, Principal Investigator). Additional authors include Dr. Sherry Pagoto and Jessica Bibeau from University of Connecticut, Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University, and Dr. Kimberly Henry from Colorado state University.

References

  1. Sexually transmitted disease surveillance 2017: other STDs. Centers for Disease Control and Prevention Web site. Available at: https://www.cdc.gov/std/stats17/other.htm#hpv. Accessed March 28, 2019.
Improving Health Communication in Three Minority Populations with Photographic Images that Increase Identification

Improving Health Communication in Three Minority Populations with Photographic Images that Increase Identification

In a recent e-publication in Health Education Research, Mary Buller, President of Klein Buendel, and her coauthors report the results of an evaluation using Real Health Photos in health communication messaging with three racial/ethnic populations (i.e., African Americans, Hispanics, and Native Americans). The study explored an approach to more effectively reach underserved populations with health messages using the homophily principal.

The homophily principle, that perceived similarities among people produce positive reactions, is a cross-cultural, global phenomenon. It is grounded in the power of identification. The study tested the prediction that photographs depicting models very similar to the target population would improve health communication by increasing perceived identification and increase the target populations’ intentions to change behavior in a favorable, more healthful direction.

To test the hypothesis, three nationally-representative stratified samples of adults (n=1,638) who were African American, Hispanic, or Native American were selected from a large national survey panel. Participants read an identical message promoting increased moderate to vigorous physical activity and decreased intake of high fat, high sugar, and high carbohydrate foods. Photographs from a commercial stock photograph service versus photographs created for the research project to match the three populations — from Real Health Photos®– were included in the messages. Participants responded to assessments of behavioral intentions, outcome and self-efficacy expectations, and identification.

Structural equation modeling confirmed the theoretical hypothesis that Real Health Photos which matched the minority population increased behavioral intentions and was mediated by identification in all three racial/ethnic minority samples. Messages with only half of the matched Real Health Photos images had these same positive indirect effects among African Americans and Hispanics. The impact of matching visual images in health messages to recipients derived from identification with the people in the images. Homophily and identification are hard-wired, evolutionary, biological phenomena that can be capitalized on by health educators with minority populations to improve message effectiveness.

Real Health Photos is a unique collection of images of people with diversity of age, gender, race, ethnicity, income level, and health condition. The collection was produced by Klein Buendel to portray the diversity of health through photography and promote the inclusion of all populations in health promotion materials and media.

The development of Real Health Photos and this research were funded by a Small Business Innovation Research grant from the National Institute of Minority Health and Health Disparities (MD003338; Mary Buller, Principal Investigator). Coauthors include Dr. Peter Andersen from San Diego State University, Dr. Michael Slater from The Ohio State University, Lyndsay Fluharty from Telligen, Inc., Dr. Kim Henry from Colorado State University, and Dr. Erwin Bettinghaus, Xia (Lucia) Liu, Steven Fullmer, and Dr. David Buller from Klein Buendel. Many of the Real Health Photos used in this study were taken by Delia Palmisano from Blue House Photography in Denver, Colorado.

Development of Educational Modules to Enhance Care of Aged and Dying Inmates

Development of Educational Modules to Enhance Care of Aged and Dying Inmates

The United States has the highest rate of incarceration in the world and the demographics of the prison inmate population are shifting and aging. Many older adults are serving extended sentences and will age and die in place — making geriatric and end-of-life care an essential educational foci for prison staff. Consequently, resources are needed to adequately prepare prison staff to address this growing concern.

In a recent publication in Public Health Nursing, a research team led by Dr. Susan Loeb from Penn State University and including Klein Buendel (KB) Senior Scientist, Dr. Valerie Myers, reports on the development of educational modules to enhance the care of aged and dying inmates in prisons. The article describes the strategies used to “set-up” the Enhancing Care for the Aged and Dying in Prisons (ECAD-P) educational modules. “Set-up” is the first of four phases in the Institute for Healthcare Improvement (IHI) Framework for Going to Full Scale, which served as the conceptual framework for this study. Objectives achieved during the Set-up phase include: (a) establishing an approach for infusing the intervention into the target system; (b) identifying the product that needs scaling-up; and (c) determining what will be accomplished in the full-scale phase. Also, program buy-in within the given context and identification of the test sites, as well as support by early adopters, are essential.

The design approach for the educational modules included an environmental scan, a modified Delphi study, and a usability study.

An environmental scan provided a foundational understanding of the complex, contextual factors that impact correctional settings in the United States. Specifically, the environmental scan of diverse correctional settings helped to determine current educational approaches, education and learning preferences of personnel, and the technological capacity to deliver computer-based educational modules. Gaining knowledge was essential for the targeted development of modules that are tailored to address the health needs of the growing numbers of older inmates, many of whom will remain incarcerated through their end of life.

The Delphi process uses iterative group facilitation to forge reliable consensus on the opinion of experts through a series of structured questionnaires or rounds. The goal is to secure expert judgment based on experience. A Delphi survey was conducted early in the Set-Up phase to identify essential geriatric content for integration into the new prototype learning modules. The outcome was a reliable consensus on essential geriatric content for inclusion into the newly rebranded ECAD-P modules. An Expert Advisory Board reviewed the findings and validated the results.

For the usability assessment, the research team collaborated to design and program three media-rich, interactive computer-based prototype modules designed for the corrections context. The prototype, containing three modules, was built using Axure development software. The prototype was self-contained on a laptop computer. Each module had learning objectives, content delivered through multiple interactive features (for example: drag and drop, hover, click and reveal, video) and a final comprehension check quiz. Usability and acceptability testing were assessed following an established protocol examine navigability, detect problems, observe time spent solving problems, identify problem severity, and develop recovery strategies. After usability testing, the participants completed the System Usability Scale, a validated tool for assessing the usability and acceptability of technology-based products. Testing was conducted with 16 participants at two state correctional institutions in one mid-Atlantic state.

A full description of the methods, results, conclusions, and limitations of this study, as well as the implications for public health nursing, can be found in Public Health Nursing. This research was funded by a Small Business Technology Transfer (STTR) grant to KB from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb, Principal Investigator). Other collaborators/coauthors include Dr. Janice Penrod, Dr. Erin Kitt-Lewis, Dr. Rachel Wion, and Brenda Baney from Penn State University; and Sophia Strickfaden from Johnson & Wales University. KB’s Creative Team produced the ECAD-P prototype modules.