Way to Serve Sells 100,000 Trainings

Way to Serve Sells 100,000 Trainings

WayToServe®, an evidence-based online responsible alcohol server training program, has sold its 100,000th training!

WayToServe was created by scientists and developers from the University of New Mexico, the Pacific Institute for Research and Evaluation, and Klein Buendel. The engaging, media-rich program was initially evaluated in a controlled randomized trial that resulted in high trainee satisfaction and increased refusal of sales to intoxicated patrons. WayToServe was licensed to Wedge Communications, LLC and launched into the online marketplace in 2012. To date, WayToServe has been tailored and approved for sale and certification of trainers in California, Texas, Washington, and New Mexico.

To meet the needs of Spanish-speakers, Klein Buendel is currently testing a companion program, WayToServe Español. “WayToServe Español es muy importante! It could help saves lives,” said Dr. W. Gill Woodall, the project’s director. The unique Spanish-language training program will be on the market in 2021.

The original WayToServe program was funded by two grants from National Institute on Alcohol Abuse and Alcoholism to the University of New Mexico (AA014982 and AA016606; Dr. W. Gill Woodall, Principal Investigator). The WayToServe Español program is funded by a grant from the National Institute of Minority Health and Health Disparities (MD010405; Dr. W. Gill Woodall, KB Senior Scientist, Principal Investigator).

Family Determinants of Sun-Safe Behaviors in Hispanic Children

Family Determinants of Sun-Safe Behaviors in Hispanic Children

Melanoma is common, particularly among Non-Hispanic Whites (NHW). However, Hispanics are diagnosed at more advanced stages compared to NHW prompting the need for more research into Hispanic sun protection practices.  

Sarah Davila, Klein Buendel collaborator and student from Claremont Graduate University, recently presented findings on family determinants of child sun protection from the Sun Safe Schools project at the virtual 2020 American Public Health Association conference. Family determinants of child sun protection have seldom been tested among Hispanics. The team hypothesized that parent sun protection behavior, perceived risk for skin cancer, skin-phenotype, and purchase of sun protection products, along with child skin-phenotype and interaction of child skin-phenotype with child ethnicity would associate with child sun protection behavior and child sunburn. To test this, parents of elementary school-aged children completed self-report surveys and a multilevel analysis was conducted with Hispanic and NHW parents nested within schools and nested within districts.  

Parent sun protection behavior, number of sun-safe items purchased, and child skin-phenotype were all positively associated with child sun protection behavior, while parent perceived risk was negatively associated. The interaction of child skin-phenotype with child ethnicity was significant, indicating no difference at Type 1 skin-phenotype, but greater protective behavior for Hispanics relative to NHW for subsequent skin-phenotypes. Parent perceived risk and child skin-phenotype were also positively associated with child sunburn. Overall, the results suggest a need for parent modeling and environmental controls to increase sun protection behavior in Hispanic children.  

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 included 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 Julia Berteletti, Mary Buller, and Lucia Liu from Klein Buendel. 

Dr. Christie Rizzo

Dr. Christie Rizzo

Christie J. Rizzo, Ph.D., is an Associate Professor of Applied Psychology at Northeastern University, and maintains an appointment as an Adjunct Associate Professor of Psychiatry and Human Behavior at Brown University. Dr. Rizzo is leading a collaboration with Klein Buendel to create a Spanish version of Project STRONG, a web-based dating violence prevention program for parents and middle school boys. The interactive, technolyg-delivered curriculum is grounded in Developmental Assets Theory which asserts that family support, knowledge, values development, and social skills are necessary for healthy development and offset the emergence of risky behavior. Project Strong is funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD097126; Dr. Christie Rizzo, Principal Investigator).

Dr. Rizzo received her Ph.D. in Clinical Psychology from the University of Southern California. Much of her research focuses on the development and implementation of evidence-based, violence and risk behavior prevention programming for youth, including technology-based initiatives. She particularly focuses on vulnerable youth, such as those involved in the child welfare and juvenile justice systems. Dr. Rizzo was previously the Assistant Director of the Juvenile Mental Health Clinic at the Rhode Island Family Court. She now directs the Adolescent Relationships and Risk Behavior Lab at Northeastern University.

Along with Project STRONG, Dr. Rizzo’s current research projects include: 1) Dating Violence Prevention for Juvenile Justice Girls, and 2) Dating Violence Perpetration among Juvenile Justice Youth: The Role of Social, Behavioral, and Ecological Processes.

Health Literacy and Genomic Testing for Melanoma

Health Literacy and Genomic Testing for Melanoma

Dr. David Buller, Klein Buendel’s Director of Research, is a co-author on a paper published recently in Patient Education and Counseling that examines how health literacy skills impact primary care patients’ understanding of melanoma genetic testing results. The paper’s lead author is Dr. Kimberly Kaphingst from the Huntsman Cancer Institute and the Department of Communication at the University of Utah. Additional co-authors are from the Memorial Sloan Kettering Cancer Center in New York, and the Department of Internal Medicine at the University of New Mexico.

Making a significant health decision can be burdensome. It involves obtaining, processing, and weighing an abundance of new information. Personal health literacy skills may help lighten the load. According to the U.S. Department of Health and Human Services, “personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”

The Patient Education and Counseling paper describes the methods and measures used to examine whether health literacy skills, educational attainment, or melanoma risk were related to patients’ short-term cognitive and affective responses to personal melanoma genetic test results. Cognitive responses that were measured included perceived clarity and believability of the test results, and how often respondents thought about the test results. Affective reactions that were assessed included things like confusion, fear, hopefulness, relief, and regret, among others. Study results, conclusions, limitations, and implications are reported in the publication. Overall, the authors report that some individuals may need assistance in understanding genetic information related to melanoma risk.

This research was supported by the National Cancer Institute (CA181241; Dr. Jennifer Hay and Dr. Marianne Berwick, Multiple Principal Investigators) and the Huntsman Cancer Foundation.

Tattoo Aftercare Instructions and Sun Protection

Tattoo Aftercare Instructions and Sun Protection

Skin cancer rates continue to rise in the United States, so health researchers continue to explore novel ways to reach people with potentially life-saving information. In a recent commentary published in the Journal of Clinical and Aesthetic Dermatology, Klein Buendel Senior Scientist, Dr. Barbara Walkosz, and co-authors discuss how tattoo studios and their aftercare instructions provide a unique opportunity to reach younger adults with skin cancer prevention recommendations.

Sun protection for new tattoos, to some degree, is provided to most clients as part of the tattoo aftercare process. However, most aftercare instructions focus on the protection of the client’s tattooed skin, not comprehensive full-body sun protection. Most artists are not prepared to impart thorough sun safety recommendations, “such as applying sunscreen prior to sun exposure with a sun protection factor (SPF) of 30 or higher, reapplying sunscreen when outdoors for more than two hours, using clothing that physically blocks ultraviolet rays, wearing wide-brimmed hats that shade the head, or seeking shade when available.”

However, research suggests that tattoo artists are interested in learning about sun safety measures and open to sharing the information with their clients. In the commentary, the authors pinpoint the unique opportunity tattoo studios provide to reach younger adults with public health information, including through studio websites and social media pages. The commentary also shares results from in-depth interviews with tattoo artists and describes how tattoo aftercare instructions vary from state to state.

This research team was funded by a grant and supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Authors include Dr. Cristian Gonzalez from the Department of Dermatology at 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.  

Scaling-up an Evidence-based Workplace Sun Safety Program

Scaling-up an Evidence-based Workplace Sun Safety Program

Authors of a recent online publication in Contemporary Clinical Trails recommend that “successful methods for scaling-up evidence-based programs are needed to prevent skin cancer among adults who work outdoors in the sun.” The paper describes the design and baseline descriptive data from a workplace intervention being conducted by Klein Buendel and several research collaborators. The on-going randomized trial compares two methods of scaling-up the Sun Safe Workplaces intervention with 21 state Departments of Transportation and their employees who work outdoors. 

A total of 138 regional districts from the Departments of Transportation were randomly assigned to either an in-person program where project staff meet personally with managers, conduct trainings for employees, and provide printed materials, or a digital program where project staff conduct these same activities virtually, using conferencing technology, online training, and electronic materials.

Delivery of Sun Safe Workplaces in both groups is tailored to managers’ readiness to adopt occupational sun safety. Posttesting will assess manager’s support for and use of Sun Safe Workplaces and employees’ sun safety. An economic evaluation will explore whether the method that uses digital technology that may result in lower implementation of Sun Safe Workplaces, is more cost-effective relative to the in-person method.

The 21 state Departments of Transportation vary in size from 997 to 18,415 employees. At baseline, managers reported being generally supportive of occupational sun safety. A minority reported that the Departments had a written sun safety policy, half reported sun safety training for employees, and two-thirds reported messaging and communication about sun protection for employees. The research will help determine whether digital methods can facilitate a cost-effective scale-up of Sun Safe Workplaces for outdoor workers in industries across the country.  

This research project (CA210259) is funded as part of the National Cancer Institute’s Cancer Moonshot Initiative, which aims to accelerate cancer research in order to make more therapies available to patients, while also improving the ability to prevent cancer and detect it at an early stage. This project, Sun Safe Workplaces-Technology, is being led by KB’s Director of Research, Dr. David Buller, as Principal Investigator. Co-authors on the Contemporary Clinical Trails publication include Dr. Richard Meenan from Kaiser Permanente’s Center for Health Research, Dr. Gary Cutter from Pythagoras, Inc., Dr. Sherry Pagoto from the University of Connecticut, and Ms. Mary Buller, Ms. Julia Berteletti, Ms. Rachel Eye, and Dr. Barbara Walkosz from Klein Buendel.

Sun Safe Partners Online

Sun Safe Partners Online

Findings from a pilot randomized controlled trial evaluating the feasibility and preliminary impact of an online couple-focused intervention to improve sun protection behavior were published recently in the Journal of Medical Internet Research. The research team was led by Dr. Sharon Manne from the Rutgers Cancer Institute of New Jersey. Collaborators from Michigan State University, the University of Connecticut, Memorial Sloan Kettering Cancer Center, and Klein Buendel rounded out the research team.

At the time of the study, Sun Safe Partners Online was a web-based intervention with four individual-focused modules and four couple-focused modules. A total of 75 couples who reported suboptimal levels of sun protection were randomly assigned to receive either Sun Safe Partners Online or a generic sun safety education intervention. Participants were recruited through Facebook advertising, resulting in rapid enrollment and higher acceptance than was evident in a previous trial testing telephone and print intervention. Feasibility was assessed by enrollment, engagement, survey completion, module completion, and module satisfaction. Participants also completed pre/post surveys assessing sun protection, sun exposure on weekends, sunburn incidence, and attitudes toward sun protection. A full description of the methods, analyses, and effects of the study can be found in the publication.

Sun Safe Partners Online was found to be an innovative strategy for engaging adults in sun safety. The authors conclude that “a couple-focused intervention may hold promise as a way to improve sun protection behaviors beyond interventions focused solely on individuals by leveraging the concern, collaboration, and support among intimate partners and addressing relationship-based barriers to sun protection.”

This pilot research was supported by Rutgers Cancer Institute of New Jersey Institutional funds.

Testing The Impact Of Social Media Messaging On COVID-19 Mitigation

Testing The Impact Of Social Media Messaging On COVID-19 Mitigation

Klein Buendel researchers and collaborators are launching a supplemental study to test the impact of social media messaging on COVID-19 mitigation, such as social distancing behaviors and vaccination, in a sample of mothers with daughters aged 14-17 years. The study, which is funded by the National Cancer Institute, will examine the impact of different sources frequently providing COVID-19 and vaccination information via Facebook.

The Internet, including social media, is a preferred channel for health information for many Americans (1,2). At their best, social media provide flexible, responsive, and accessible platforms for distributing information to the public from trusted voices such as Centers for Disease Control and Prevention (CDC) and National Institutes of Health to promote needed health behaviors (3,4). Social media can improve information dissemination and personal relevance (8-12), create social support and collective action (13,14), and detect and respond to emerging issues and trends such as the COVID-19 response (5,6). At their worst, social media circulate inaccurate, misleading, unsupported, and harmful information (5,7), which may be especially detrimental in this age of filter bubbles separating Americans into like-minded groups (5).

Following a pretest survey, mothers will be randomly assigned to one of three Facebook private groups varying in types of source in the COVID-19 social media posts – government health agencies, near-peer parents and family members, or news media. Social media platforms are directing users to health organizations (6) but other sources may be credible with users, as well. The private groups prevent experimental contamination while delivering the social media feed. Mothers will complete a posttest at 3-, 6-, and 9-weeks post-randomization. The primary outcomes, assessed at pretest and all posttests, will be social distancing behaviors by self and daughter and intention to vaccinate self and daughter for COVID-19 (if a vaccine becomes available). Secondary outcomes are mother-daughter communication about COVID-19 mitigation behaviors and vaccination, theoretic antecedents of mitigation behaviors and vaccination, media literacy, and COVID-19 misinformation. Individual differences among mothers and other covariates will be measured at baseline or obtained from the parent trial. Engagement with the social media feed will be recorded.

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


1. Purcell K; Pew Research Center. The State Of Online Video. Available at: http://www.pewinternet.org/2010/06/03/the-state-of-online-video/. Published June 3 2010. Accessed May 22, 2020.

2. Majority of Adults Look Online for Health Informaiton. FactTank: News in the Numbers. February 1, 2013. http://www.pewresearch.org/fact-tank/2013/02/01/majority-of-adults-look-online-for-health-information/. Accessed May 22, 2020.

3. Veil SR, Buehner T, Palenchar MJ. A work-in-process literature review: incorporating social media in risk and crisis communication. J Contingencies Crisis Manage. 2011;19(2):110-122.

4. Breland JY, Quintiliani LM, Schneider KL, May CN, Pagoto S. Social media as a tool to increase the impact of public health research. Am J Public Health. 2017;107(12):1890-1891.

5. Sutton J. Health communication trolls and bots versus public health agencies’ trusted voices. Am J Public Health. 2018;108(10):1281-1282.

6. Merchant RM, Lurie N. Social media and emergency preparedness in response to novel coronavirus [published online ahead of print March 24, 2020]. JAMA. 2020 doi: 10.1001/jama.2020.4469

7. Broniatowski DA, Jamison AM, Qi S, et al. Weaponized health communication: Twitter bots and Russian trolls amplify the vaccine debate. Am J Public Health. 2018;108(10):1378-1384.

8. Valle CG, Tate DF, Mayer DK, Allicock M, Cai J. A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors. J Cancer Surviv. 2013;7(3):355-368.

9. Young SD, Cumberland WG, Lee SJ, Jaganath D, Szekeres G, Coates T. Social networking technologies as an emerging tool for HIV prevention: a cluster randomized trial. Ann Intern Med. 2013;159(5):318-324.

10. Pagoto S, Baker K, Griffith J, et al. Engaging moms on teen indoor tanning through social media: protocol of a randomized controlled trial. JMIR Research Protocols. 2016;5:e228. doi: 10.2196/resprot.6624. PMCID: PMC5147712

11. Witte K. Putting the fear back in fear appeals: the extended parallel process model. Communication Monographs. 1992;59:329-349.

12. Rogers RW. A Protection Motivation Theory of fear appeals and attitude change1. J Psychol. 1975;91(1):93-114. doi: 10.1080/00223980.1975.9915803

13. Rogers RW. Cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation. In: Cacioppo, J, Petty, R, eds. Social Psychophysiology. New York, NY: Guilford Press; 1983:153-176.

14. Woodall GW, Starling R, Buller DB, Kong A, Wheeler C. Beta-test and randomized trial results for GoHealthyGirls: a website for HPV vaccine adoption. 29th Meeting of the International Papillomavirus Conference; August 20-25; Seattle, Washington.

Sales of Recreational Cannabis to Alcohol-Intoxicated Customers

Sales of Recreational Cannabis to Alcohol-Intoxicated Customers

To prevent harm, some U.S. states have laws prohibiting the sale of recreational marijuana to alcohol-intoxicated customers. In a recent publication in the International Journal of Drug Policy, Klein Buendel researchers and collaborators evaluated an online responsible marijuana vendor (RMV) training program – Train to Tend – and its performance at deterring sales to apparently alcohol-intoxicated customers in recreational cannabis stores. Much like the training of responsible alcohol sales practices, RMV training may prove beneficial for helping to keep customers and communities safe.

One hundred fifty stores from Colorado, Oregon, and Washington were enrolled in the randomized controlled trial. Half of the stores were randomly selected to receive Train to Tend training. One of the five online training modules addressed recognizing signs of impairment and intoxication, refusing sales to intoxicated patrons, and understanding the risks of driving under the influence of cannabis.

The evaluation employed pseudo-patron pairs, one of which displayed obvious signs of alcohol intoxication. The refusal of cannabis sales to the pseudo-intoxicated buyers was very low. In some cases, store personnel made comments or expressed suspicion towards buyers’ behavior, but continued with the sale nonetheless. Refusal rates between intervention and control stores were not significantly different. Overall, responsible marijuana vending practices alone did not appear to influence the reduction of marijuana sales to customers with obvious signs of alcohol intoxication. A full description of the methods, results, and discussion can be found 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). Co-authors on the publication include Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation in California; Dr. Gary Cutter from the University of Alabama, Birmingham; and Dr. W. Gill Woodall, Andrew Grayson, and Sierra Svendsen from Klein Buendel.

Using Machine Learning Techniques to Predict Sunburn Risk in Outdoor Exercisers

Using Machine Learning Techniques to Predict Sunburn Risk in Outdoor Exercisers

In response to recreational UV exposure being associated with skin cancer (1), Julia Berteletti, MSW, and David Buller, PhD, of Klein Buendel have launched a new research project to harness technology to increase individual’s sun safety during outdoor physical activity. The title of the new project is “Using Retrospective and Real-Time Physical Activity Tracking to Predict Risk of Sunburn in Outdoor Exercisers on Strava.”

The Strava Sun Project is based on evidence that individuals who engage in more physical activity have a higher prevalence of sunburn (2, 3-6), a proximal biomarker of melanoma risk, and melanoma is positively associated with physical activity (7). For some athletes, forgetting to apply sunscreen (8,9) or not liking its feel while engaged in physical activity can be barriers to sun protection (8,10). An expert meeting hosted by the National Cancer Institute identified sun safety during physical activity as a priority research area (11) and the U.S. Surgeon General prioritized strategies for coordinating messages on sun safety and physical activity in the Call to Action to Prevent Skin Cancer (12).

Online and mobile technologies for tracking physical activity have exploded over the past decade. Many Americans wear activity trackers or GPS-enabled devices, such as  Fitbit and Garmin, and upload their physical activity data to websites/mobile apps. Strava, an activity tracking app and social networking site for athletes of all abilities, is one of the most popular. Millions share their own activities and follow and comment on physical activity by other users in their network. The goal of this project is to increase skin cancer prevention among a high-risk population, adults who engage in outdoor physical activity by establishing feasibility of interfacing sun protection advice with the Strava website/mobile app.

Specifically, the research will create an algorithm that predicts when individuals are likely to be engaged in physical activity outdoors, and delivers sun safety advice tailored to time, location, and personal risk (for example, skin sun sensitivity). The Strava Sun program will obtain user data and deliver ecologically-valid sun safety advice by utilizing Strava’s open-source Applications Programming Interface (API) and location-based advice algorithms developed by Klein Buendel for the sun safety mobile app, sunZapp (13). Machine learning techniques will be employed to develop an algorithm using Strava activities to predict high-risk behavior, such as outdoor physical activity when UV levels are high and sun safety is advised.

Overall, a sun protection interface for the Strava platform will allow for the identification of a large population of Americans at high risk for skin cancer who routinely engage in physical activity, often outdoors with high-risk sun exposure, and reach them with sun safety advice they may not seek on their own to motivate them to practice sun safety during outdoor activities.

This project is funded by a grant from the National Cancer Institute at the National Institutes of Health (CA241637; Dr. David Buller and Ms. Julia Berteletti, Multiple Principal Investigators). Co-Investigators include Dr. Kim Henry and Dr. Chuck Anderson from Colorado State University. Other collaborators include Dr. Sherry Pagoto from the University of Connecticut and Mr. Scott Camichael, a recent software engineer at Strava. Developers at Klein Buendel will produce the API database and program.


  1. Moehrle M. Outdoor sports and skin cancer. Clin Dermatol. 2008;26(1):12-15.
  2. Holman DM, Ding H, Guy GP, Jr., Watson M, Hartman AM, Perna FM. Prevalence of Sun Protection Use and Sunburn and Association of Demographic and Behaviorial Characteristics With Sunburn Among US Adults. JAMA Dermatol. 2018;154(5):561-568.
  3. Holman DM, Berkowitz Z, Guy GP, Jr., Hartman AM, Perna FM. The association between demographic and behavioral characteristics and sunburn among U.S. adults – National Health Interview Survey, 2010. Prev Med. 2014;63:6-12.
  4. Hall HI, Saraiya M, Thompson T, Hartman A, Glanz K, Rimer B. Correlates of sunburn experiences among U.S. adults: results of the 2000 National Health Interview Survey. Public Health Rep. 2003;118(6):540-549.
  5. Coups EJ, Manne SL, Heckman CJ. Multiple skin cancer risk behaviors in the U.S. population. Am J Prev Med. 2008;34(2):87-93. doi: 10.1016/j.amepre.2007.09.032
  6. Lawler S, Sugiyama T, Owen N. Sun exposure concern, sun protection behaviors and physical activity among Australian adults. Cancer Causes Control. 2007;18(9):1009-1014.
  7. Moore SC, Lee IM, Weiderpass E, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016;176(6):816-825.
  8. Petty KN, Knee CR, Joseph AK. Sunscreen use among recreational cyclists: how intentions predict reported behavior. J Health Psychol. 2012;18(3):439-447.
  9. Wysong A, Gladstone H, Kim D, Lingala B, Copeland J, Tang JY. Sunscreen use in NCAA collegiate athletes: Identifying targets for intervention and barriers to use. Prev Med. 2012;55(5):493-496.
  10. Berndt NC, O’Riordan DL, Winkler E, McDermott L, Spathonis K, Owen N. Social cognitive correlates of young adult sport competitors’ sunscreen use. Health Educ Behav. 2011;38(1):6-14.
  11. Geller AC, Jablonski NG, Pagoto SL, et al. Interdisciplinary perspectives on sun safety. JAMA Dermatol. 2018;154(1):88-92. PMC5839662.
  12. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Surgeon General;2014.
  13. Heron KE, Smyth JM. Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol. 2010;15(Pt 1):1-39.