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#4Corners4Health: Protocol for a Randomized Stepped-Wedge Trial

#4Corners4Health: Protocol for a Randomized Stepped-Wedge Trial

Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico are leading a large multiple state research team on the design, implementation, and evaluation of #4Corners4Health. The research study aims to decrease cancer risk factors among emerging adults (ages 18-26) living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah using a targeted social media campaign. The team has published a full description of their study procedures in JMIR Research Protocols.

Many emerging adults are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among emerging adults delivered over social media is limited. Cancer prevention information and recommendations may reach emerging adults more effectively over social media than in settings such as health care, schools, and workplaces, particularly for emerging adults residing in rural areas.

Specifically, the research team will recruit a sample of 1000 emerging adults aged 18 to 26 years residing in rural counties in the Four Corners states from the Qualtrics’ research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and HPV vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and emerging adults and focus groups with emerging adults. The emerging adults will complete assessments at baseline and five additional data after randomization. Assessments will measure six cancer risk behaviors, theoretical mediators, and participants’ engagement with the social media campaign.

The trial is being led by a steering committee. Team members are working in three subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by emerging adults, and community resources available. A framework for the social media intervention with topics, format, and theoretical mediators has been created, along with protocols for social media management.

In summary, the researchers believe that social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among emerging adults. Because of the popularity of web-based information sources among emerging adults, an innovative, multiple risk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

This research is supported by a 5-year R01 grant from the National Cancer Institute (CA268037) to Klein Buendel. Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico are the project’s Multiple Principal Investigators. The JMIR publication has 24 collaborating authors from multiple institutions.

Usability Evaluation of the ezParent Administrative Dashboard

Usability Evaluation of the ezParent Administrative Dashboard

A team from Ohio State University and Klein Buendel has published results from the usability testing of the ezParent administrative dashboard in JMIR Formative Research. ezParent is a web-based training program for parents of children ages 2-6 years. It provides behavioral training through brief videos, interactivity, reflection questions, and assessments to parents of young children. 

Web-based parent training programs can strengthen parent-child relationships. They can help equip caregivers with knowledge and evidence-based strategies to manage behavior. They also can help surmount some logistical and personal barriers of in-person parent training. Web-based administrative dashboards provide administrators, facilitators, researchers, and others with detailed information about their participants’ usage, which can strengthen delivery of the intervention. Despite the utility of administrative dashboards, the authors know of no other research studies that have explored the perspectives and insights of dashboard users.

The study described in JMIR Formative Research used a descriptive, single-group survey design with four administrators who were overseeing implementation of the ezParent program and 19 trained facilitators for hybrid ezParent delivery. Participants were instructed to spend 30 minutes reviewing and assessing the ezParent dashboard and then prompted to complete a survey of their interaction with it. The survey included the validated 10-item System Usability Scale (SUS) and some open-ended questions.

Fifteen respondents indicated high usability of the ezParent dashboard, with a total mean SUS score of 83.5. Most participants (87%) rated the user-friendliness of the dashboard as good (20%), excellent (60%), or best imaginable (7%). Open-ended questions revealed the dashboard would be useful to monitor parent progress (40%), communicate with parents (13%), to review topics for discussion (20%), and to identify trends in parent participation (13%). ezParent administrators identified real-time data for ezParent users helps overall management of program uptake. Suggestions for features to add to the dashboard included the ability to track partial progress of program modules (29%), total time spent per module (14%), and exportable reports (7%). Other ideas for improvement included direct messaging capabilities, video-conferencing platform integration, and the ability to modify participant account and contact information.

Results indicate that the dashboard is easy to use and provides functional information to facilitators and administrators in delivering ezParent. Providing resources to aid in facilitation of the hybrid intervention may foster improved parent uptake and outcomes. Integrating suggested features into the dashboard may help provide a smoother experience for facilitators, administrators, and parents using the program.

This research was sponsored by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD104072; Dr. Susan Breitenstein, Principal Investigator, Ohio State University). Collaborating authors include Ms. Julia Berteletti and Mr. Charlie Barger from Klein Buendel; and Shea Smoske, Kyrie Tipps, and Nathan P. Helsabeck from The Ohio State University. The ezParent web-based program and administrative dashboard were programmed by the Creative Team at Klein Buendel.

Professional Development to Improve Responsible Beverage Service Training 

Professional Development to Improve Responsible Beverage Service Training 

Research collaborators from Klein Buendel and the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE) have published formative research results and a protocol for a randomized controlled trial in JMIR Research Protocols.  

The full trial will be evaluating an addition to a responsible beverage service (RBS) training because improved interventions are needed to reduce the rate of driving while intoxicated. RBS training has reduced service to intoxicated patrons in licensed premises in several studies. Its efficacy might be improved by increasing the proper application and continued use of RBS with a professional development program in the 3 to 5 years between the required RBS retraining. 

The formative research published in JMIR Research Protocols reports on the addition of a professional development component to an existing RBS training to improve the effectiveness of the web-based training alone. Semi-structured interviews with owners and managers of licensed establishments and focus groups and a survey with alcohol servers in New Mexico and Washington State were conducted to examine support for RBS and the need, feasibility, acceptability, and potential effectiveness of ongoing professional development. A prototype of a professional development component, WayToServe Plus, was produced and delivered in social media posts on advanced RBS skills, support from experienced servers, professionalism, and basic management training. The prototype included 50 social media posts. The prototype was evaluated in a usability survey and a field pilot study with alcohol servers in California, New Mexico, and Washington.  

Although owners and managers and alcohol servers were favorable toward RBS, they endorsed the need for ongoing support for RBS for servers and identified topics of interest. Servers felt that the professional development component was highly usable and appropriate for themselves and the premises in the usability survey (n=20) and field pilot test (n=110), with 85% and 78%, respectively, saying they would use it. Servers receiving the professional development component had higher self-efficacy and response efficacy for RBS compared with untreated controls. 

The article also includes a protocol for a planned randomized controlled trial. This phase of the project will include full production of the professional development component. It will be delivered in Facebook private groups over 12 months and evaluated with a sample of licensed premises (bars and restaurants) in California, New Mexico, and Washington (n=180) in a 2-group randomized field trial (WayToServe training only compared to WayToServe training and WayToServe Plus). Licensed establishments will be assessed for refusal of sales to apparently intoxicated pseudo-patrons at baseline and 12 months after the intervention commences. 

Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed premises. Servers were interested in using such a program, a large majority engaged with a prototype, and servers receiving the prototype improved on theoretic mediators of RBS. The authors believe that the professional development component may improve RBS training and save lives. 

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

Serving Alcohol to Obviously Intoxicated Patrons

Serving Alcohol to Obviously Intoxicated Patrons

Klein Buendel scientists and staff are co-authors on a new publication of research results with scientists from the Pacific Institute for Research and Evaluation (PIRE) in the Journal of Studies on Alcohol and Drugs (JSAD). The study, led by PIRE, examines alcohol over-service at bars, nightclubs, restaurants, etc. in California which is associated with driving while intoxicated, violence, and other problems.

Three hundred licensed bars, night clubs, restaurants, etc. were sampled in 2022 in nine counties representing the San Francisco Bay Area. Combination pseudo-patron and observer teams visited each on-premise establishment where the pseudo-patrons attempted to buy alcohol while displaying obvious signs of intoxication. The JSAD paper describes characteristics of the establishments, servers, pseudo-patrons, and time/date of purchase attempt that may be associated with the refusal of alcohol service.

In total, 21% of the establishments refused alcohol service to pseudo-patrons. Descriptive and regression analyses were conducted and are described in detail in the JSAD publication. According to the authors, “No establishment or server characteristics were significantly associated with service refusal in logistic regression analysis; nor were month, day, or time.” However, service refusal was significantly more likely for female pseudo-patrons and pseudo-patrons displaying obvious or very obvious signs of intoxication.

The authors assert that the study indicates that alcohol over-service to obviously intoxicated patrons remains common at licensed on-premises establishments. Mandatory responsible beverage service training of servers and enforcement of alcohol over-service laws was recently enacted in California, which may help to reduce over-service and its related problems.

This study is sponsored by a grant from the National Institute on Drug Abuse (AA028772; Dr. Robert Saltz, Principal Investigator, PIRE). Co-authors include Dr. Mallie Paschall and Dr. Sharon O’Hara from PIRE, and Dr. W. Gill Woodall, Dr. David Buller, and Ms. Lila Martinez from Klein Buendel.  

Physical Activity During the Early Days of the COVID-19 Pandemic

Physical Activity During the Early Days of the COVID-19 Pandemic

Dr. Kayla Nuss, KB Scientist, was part of a multi-institutional research team that published the results of a daily diary physical activity study in the Journal of Physical Activity and Health in July. The study, led by Ms. Kristen Moore from Colorado State University, reported on motivational profile as a predictor of physical activity among U.S. adults during the early months of the COVID-19 pandemic.

A total of 468 adults participated in a 28-day smartphone-based daily diary study assessing physical activity. Nearly 80% of the participants were female and the average age of participants was 34.8 years. Daily diaries were used to examine associations between day-level physical activity behavior, physical activity-specific motivational profile, and days since the COVID-19 national emergency declaration during the early months of the pandemic, specifically April-June 2020.

According to the publication in the Journal of Physical Activity and Health, a baseline survey assessed physical activity and motivation for physical activity using the Behavioral Regulation in Exercise Questionnaire. Multilevel linear regression models examined the main effects and interactions of motivational profile and time on daily physical activity minutes. Latent profile analysis identified four distinct motivational profiles for physical activity among this sample:

Profiles

  1. High amotivation (21% of participants)
  2. Low controlled motivation (12% of participants)
  3. High external regulation (10% of participants)
  4. Moderate autonomous motivation (57% of participants)

After controlling for baseline physical activity, there were significant interactions between profile and time on daily physical activity. Profile 2 showed greater decreases in daily physical activity minutes over time than profile 1. Profiles 3 and 4 did not indicate significant decreases in physical activity compared with profile 1. Details on the methods and results of this research can be found in the publication.

The authors summarize that Individuals with lower controlled or moderate autonomous motivation demonstrated the largest decreases in physical activity over time, whereas individuals with higher amotivation or external regulation demonstrated smaller decreases over time. In conclusion, the authors suggest that external motivation may have provided short-term protection against declines in physical activity observed during early months of the COVID-19 pandemic.

This research was supported by the Assessment and Promotion of Physical Activity and Health Lab at Colorado State University and the Real-Time Eating Activity and Children’s Health Lab at University of Southern California. Authors in addition to Ms. Moore and Dr. Nuss include Dr. Shirlene Wang and Dr. Genevieve Dunton from the University of Southern California; Dr. Kaigang Li and Dr. Dan Graham from Colorado State University; Dr. Jimikaye Courtney from the University of North Carolina, and Dr. Bridgette Do from FitMinded, Inc.

Effects of Motivational Interviewing and Wearable Fitness Trackers on Motivation and Physical Activity in Inactive Adults

Effects of Motivational Interviewing and Wearable Fitness Trackers on Motivation and Physical Activity in Inactive Adults

Despite tremendous adoption of wearable fitness trackers by adults, it is unclear if they affect physical activity engagement or motivation. In a paper published in the Journal of Sports Sciences, Dr. Kayla Nuss, Klein Buendel Scientist, and her research collaborators reported on a study to examine the combined effects of motivational interviewing and wearable fitness trackers on motivation and physical activity in inactive adults.

The authors hypothesized that combining a wearable fitness tracker (such as a FitBit®) with an effective intervention (motivational interviewing), would positively influence both motivation and physical activity. To test the hypothesis, a 12-week randomized controlled trial was conducted with 40 adults who did not meet physical activity recommendations. The four comparison groups were: (1) physical activity education only (educational control) with 10 participants, (2) use of a wearable fitness tracker (WFT) with 10 participants, (3) bi-weekly motivational interviewing sessions with 10 participants, or (4) both motivational interviewing and WFT (WFT+) with 10 participants.

Motivation and physical activity were measured though an online survey and actigraphy (a method to objectively estimate physical activity) pre- and post-intervention. Both the WFT+ and motivational interviewing groups scored higher in autonomy, competence, and relatedness for physical activity compared to the control group, which is associated with higher quality, or more autonomous forms of motivation. Further, both groups did show improvements in autonomous forms of motivations (such as interest or enjoyment) and decreased controlled forms of motivation (such as pressure or reward). Detailed descriptions of the study’s methods, recruitment efforts, measures, data analysis, outcomes, and limitations can be found in the Journal of Sports Sciences publication.

The authors detected no changes in physical activity. High autonomous motivation at baseline predicted higher post-intervention physical activity in the WFT+ group, but predicted lower post-intervention physical activity in the WFT group. The results of the study suggest that motivational interviewing alone or with a wearable fitness tracker can improve basic psychological needs and autonomous forms of motivation for physical activity, but not physical activity participation. The authors conclude that individual differences in motivation at baseline may moderate the effect of a wearable fitness tracker on physical activity. The findings add to the growing body of evidence that wearable fitness trackers can have some positive effect on adult’s physical activity.

This research was supported by Colorado State University Department of Health and Exercise Science (Dr. Kayla Nuss, Project Director). Collaborating authors included Ms. Kristen Moore from the University of Southern California; Dr. Tasha Marchant from the University of Colorado Health Sciences Center; Dr. Jimikaye Beck Courtney from the University of North Carolina-Chapel Hill; and Ms. Kathryn Edwards, Dr. Julia Sharp, Dr. Tracy Nelson, and Dr. Kaigang Li from Colorado State University.

A Protocol for Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students

A Protocol for Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students

A research team led by Dr. Anne Ray from the University of Kentucky, and including Dr. David Buller from Klein Buendel, has published (online ahead of print) the protocol for  an active research project in JMIR Research Protocols. The study is designed to curb drinking and risky sexual behavior by first-year college students using an innovative, cross-tailored, dynamic feedback (CDF) component. The intervention purposefully integrates content on the relationship between alcohol use and risky sexual behavior and leverages technology to incorporate daily assessments of student behavior and deliver weekly dynamic feedback.

Two-thirds of college students are current drinkers of alcoholic beverages. One in three college students report past month binge drinking (five or more drinks in a row), and one in ten report high intensity drinking (ten or more drinks in a row). Greater student alcohol consumption and heavy drinking on a given day are linked to increased sexual activity and risky sexual behavior, such as unprotected sex and sex with casual partners. This puts students at risk for negative health outcomes, such as sexually-transmitted infections, and other harmful consequences, such as sexual victimization.

A hybrid effectiveness-implementation design will allow the investigators to evaluate the effectiveness of the integrated personalized feedback intervention (PFI) with 600 first-year college students at two college sites in a randomized controlled trial. In addition, formative evaluation with local and national stakeholders (such as students and student affairs staff) will help to better understand factors that influence implementation and ensure its success and sustained use.

According the paper’s abstract: “This study utilizes a hybrid type 1 effectiveness-implementation design and will be conducted in three phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In Phase 2, 600 first-year college students who drink and are sexually active will be recruited from two sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months postbaseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors.” Intervention, recruitment, and implementation plans are described in JMIR Research Protocols.

This research is supported by a grant from the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (AA028246; Dr. Anne Ray, Principal Investigator). Collaborators include Dr. David Buller (Co-Investigator) from Klein Buendel. Klein Buendel’s Creative Team is developing the technology-delivered program for college students.

A Protocol for a Facebook Intervention for Young Melanoma Survivors and Their Families

A Protocol for a Facebook Intervention for Young Melanoma Survivors and Their Families

Individuals diagnosed with melanoma before the age of 40 (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE), and engagement in preventive behaviors including sun protection are recommended. Given the growing population of young melanoma survivors and their families who are at increased risk, it is surprising that no behavioral interventions have been developed and evaluated to improve risk-reduction behaviors.

In response, 16 researchers from ten institutions and organizations have developed an intervention and published its protocol in JMIR Research Protocols. Ultimately, the intervention is designed to improve skin cancer prevention and screening for young-onset melanoma survivors and their families. The authors believe the intervention’s delivery via Facebook will increase its impact because of the dissemination potential.

The randomized controlled trial will evaluate the efficacy of a Facebook intervention providing information, goal setting, and peer support to increase CSE, SSE, and sun protection for young-onset melanoma survivors and their FDRs. A sample of over 500 melanoma survivors and their FDRs will be randomly assigned to either the Young Melanoma Family Facebook Group or another Facebook group control condition. Before and after the intervention, study participants will complete measures of CSE, SSE, sun protection, attitudes, and beliefs. An additional objective is to evaluate the efficacy of the Facebook interventions on perceived stress, physical activity, and healthy eating behaviors.

The authors plan to complete study enrollment by late 2023. Data analysis will employ multilevel modeling with family as the upper-level sampling unit and individual as the lower-level sampling unit. According to the authors, “Fixed effect predictors in these models will include condition, role, sex, all 2- and 3-way interactions, and covariates.” If effective, the Young Melanoma Family Facebook program could be disseminated by dermatology practices, public health and nonprofit melanoma organizations, and existing melanoma and skin cancer Facebook groups, expanding its reach.

Paper Authors and Affiliations

Dr. Sharon Manne, Dr. Carolyn Heckman, Sara Frederick, Mara Domider, and Marissa Grosso:  Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey

Dr. Sherry Pagoto:  Department of Allied Health Sciences, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, Connecticutt

Dr. Susan Peterson:  Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, MD Anderson Cancer Center, The University of Texas, San Antonio, Texas

Dr. Deborah Kashy:  College of Social Science, Department of Psychology, Michigan State University, East Lansing, Michigan

Dr. Adam Berger:  Division of Surgical Oncology, Department of Surgery, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey

Dr. Christina Studts: Pediatrics – General Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado

Dr. Rosalyn Negron: College of Liberal Arts, University of Massachusetts Boston, Boston, Massachusetts

Dr. David Buller: Klein Buendel, Inc, Golden, Colorado

Dr. Lisa Paddock and Alexandria Kulik: Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey

Joseph Gallo: Hackensack Meridian Jersey Shore Medical Center, Hackensack Meridian Health, Neptune City, New Jersey

Morgan Pesanelli: School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey

This project was supported by a grant from the National Cancer Institute to Rutgers University (CA221854; Dr. Sharon Manne, Principal Investigator). Dr. David Buller, Klein Buendel Director of Research, is a Co-Investigator on the project.

Addressing COVID-19 Misinformation

Addressing COVID-19 Misinformation

Misinformation online can confuse consumers and influence people to dismiss vital public health advice. Health Chat team members from Klein Buendel, the University of Connecticut, and Colorado State University have published analyses of misinformation from a social media study in the Journal of Public Health Management and Practice. The purpose of the study was to examine how an epidemiological procedure for monitoring, diagnosing, and responding quickly to misinformation among members of a Facebook group may have affected debate and dropout among group members.

Facebook group participants were 303 mothers of adolescent daughters. The Facebook group was administered by a community manager. The social media feed varied the source of information in posts on four topics: social distancing, COVID-19 vaccines, digital and media literacy, and family communication about COVID-19. Mothers received one social media post each weekday in three randomly assigned Facebook private groups, covering all four topics plus one additional post on a positive non-pandemic topic to promote broad engagement. Posts in the three groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media sources in the post.

The community manager identified misinformation in mothers’ comments. Misinformation was defined as COVID-19 information in opposition to recommendations from the Centers for Disease Control and Prevention, National Institutes of Health, and/or World Health Organization. Misinformation took several forms. In some comments, mothers directly presented false information or expressed their own negative opinions or opposition toward COVID-19 prevention. In other comments, mothers presented misinformation indirectly.

Research methods and analyses are detailed in the Journal of Public Health Management and Practice paper. Most misinformation comments were in response to posts about vaccination, followed by non-pharmaceutical interventions, digital and media literacy, and family communication. The responsive epidemiological protocol exposed the mothers to credible information and appeared to prevent debate and dropout of Facebook group members.

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

iTRAC Pilot Study

iTRAC Pilot Study

A research team led by Dr. Christopher Houck from Lifespan and the Rhode Island Hospital has published a paper in the Journal of Developmental & Behavioral Pediatrics on the feasibility and acceptability of an initial digital iTRAC (Talking About Risk and Adolescent Choices) intervention. Collaborators included colleagues from the Rhode Island Hospital, the University of Oregon, Brown University, Penn State University, and Klein Buendel. iTRAC is a tablet-based intervention to promote emotion regulation skills among middle schoolers as a strategy for reducing risky behavior.

For the pilot study, adolescents aged 12–14 years were recruited from three urban schools for advisory groups (n=15), acceptability testing (n=11), and pilot testing (n=85). Youth advisory boards and expert panels tailored content, resulting in an animated intervention of instructional videos, games, and activities designed to teach emotion regulation strategies to young adolescents. Eighty-five adolescents were randomized to the 4-module digital iTRAC intervention or a wait-list control group. Adolescents and one parent completed baseline and 3-month follow-up questionnaires examining emotion regulation attitudes and behaviors. The adolescent participants also completed behavioral tasks related to distress tolerance.

Eighty-eight percent of those randomized to iTRAC completed all modules. Moderate effect sizes were found from baseline to follow-up on adolescents’ beliefs in the controllability of emotions, awareness of emotions, self-efficacy for managing emotions, perceived access to emotion regulation strategies, and use of emotion regulation strategies. Parent measures of adolescent regulation showed mixed results.

A tablet-based intervention to enhance emotion skills for youth in early adolescence was deemed feasible and demonstrated promising indicators of impact on emotional competence. Increasing adolescents’ awareness of and access to emotion regulation strategies may reduce decisions driven by transient emotions, which in turn may reduce engagement in risky behavior and resultant negative health outcomes. The authors conclude that the brief iTRAC intervention may be used to increase emotional competency among middle schoolers.

Dr. Valerie Myers and Ms. Tiffany Jerrod, both formerly from Klein Buendel, were co-authors on this publication. Research on the full production and evaluation of iTRAC is continuing with an STTR Fast Track grant to Klein Buendel from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Dr. Christopher Houck, Principal Investigator from Lifespan; HD110333). Collaborators on the current study include Dr. Wendy Hadley from the University of Oregon; Dr. David Barker from Rhode Island Hospital; and Ms. Julia Berteletti from Klein Buendel. The iTRAC modules will be programmed by Klein Buendel’s Creative Team.