Collaborator Spotlight:
Dr. Yelena Wu

Collaborator Spotlight:
Dr. Yelena Wu

Yelena Wu, PhD, is an Associate Professor in the Department of Dermatology at the University of Utah and a Research Investigator at the Huntsman Cancer Institute. She received a BA in Psychology from the University of California, Berkeley, and an MA and PhD in Clinical Child Psychology from the University of Kansas. She is also a licensed pediatric and clinical child psychologist.

Dr. Wu’s research and clinical practice center on promoting better health outcomes for children, adolescents, and young adults who have a history of cancer or who are at risk for developing cancer. A specific area of research interest is the prevention of skin cancer by improving adherence to preventive behavior recommendations among children and adolescents at increased risk for developing skin cancer.

Dr. Wu is currently the Principal Investigator on a 5-year project funded by National Cancer Institute (CA244674) to test a school-based program designed to increase adolescents’ use of sun protection and decrease participation in intentional tanning. Dr. David Buller, director of Research at Klein Buendel, collaborates as a Co-Investigator on the project.

In addition to her research, Dr. Wu provides consultations and therapeutic services to medical teams, patients, and caregivers to facilitate communication and aid in the management of cancer through the Family Cancer Assessment Clinic at the Huntsman Cancer Institute.

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

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

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

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

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

Collaborator Spotlight:
Dr. Carolyn Heckman

Collaborator Spotlight:
Dr. Carolyn Heckman

Dr. Carolyn J. Heckman is an Associate Professor of Medicine and Co-Leader of the Cancer Prevention and Control Program at the Rutgers Cancer Institute of New Jersey. She received a BA in Psychology from Brown University and PhD in Counseling Psychology from the University of Iowa. She completed a postdoctoral fellowship in health psychology and addictions at Virginia Commonwealth University. She is also a licensed psychologist.

Dr. Heckman has published more than 100 research papers and presented at many national and international conferences. Much of her work focuses on skin cancer prevention and detection. Her other interests include online interventions and tobacco use and cessation. She has been funded numerous times by the National Cancer Institute and has also received funding from the American Cancer Society and Pfizer, Inc.

In addition to her research, Dr. Heckman is a member of the NIH Community Level Health Promotion study section and she is on the Editorial Board of the journal Translational Behavioral Medicine. She is the Founder/Leader of the Cancer Institute of New Jersey’s Dissemination and Implementation Science Working Group. Dr. Heckman has served on several steering and advisory, grant review, search committee, training, and other committees and community groups. For example, she served as the National Chair of the Don’t Fry Day skin cancer prevention awareness campaign sponsored by the National Council on Skin Cancer Prevention.

Currently, Dr. Heckman is a Co-Investigator on a five-year R01 study called “A Multi-Level Investigation of U.S. Indoor Tanning Policy Enactment, Implementation, Compliance, Impact, and Economics” with Klein Buendel’s Dr. David Buller. The goals of this research project are to complete three specific aims: 1) conduct a comparative case study to elucidate the indoor tanning legislation adoption process; 2) use a pseudo-patron (confederate) assessment, national survey, and archival data to investigate indoor tanning legislation implementation, as well as indoor tanning and sunburn outcomes among adolescents and young adults; and 3) integrate data from the first two aims and external data to assess economic effects relevant to policy sustainability of indoor tanning stringency, enforcement, and compliance.

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Persisting Effects of the Health Chat Program

Persisting Effects of the Health Chat Program

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

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

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

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

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

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

ezPreemie Project

ezPreemie Project

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

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

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

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

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

2021 Research Highlights

2021 Research Highlights

Klein Buendel (KB) scientists and staff conducted rigorous behavioral science research with numerous collaborators from across the country in 2021. Our investigators published (or e-published ahead of print) 16 research papers in peer-reviewed journals and presented research findings virtually at 8 national or international conferences. In addition, our investigators are Principal Investigators or Co-Investigators on 6 new research projects that launched this year.

Publications

KB investigators, staff, and collaborators published or e-published the following research papers this year (current or recent investigators and staff are indicated in bold type):

Midgett A, Doumas DM, Myers VH, Moody S, Doud A. Technology-Based Bullying Intervention for Rural Schools: Perspectives on Needs, Challenges, and Design. Rural Ment Health. 2021 Jan;45(1):14-30. doi: 10.1037/rmh0000151.

Buller DB, Woodall WG, Saltz R, Grayson A, Buller MK, Cutter GR, Svendsen S, Liu X. Randomized Trial Testing an Online Responsible Vendor Training in Recreational Marijuana Stores in the United States. J Stud Alcohol Drugs. 2021 Mar;82(2):204-213.

Lee H, Henry KL, Buller DB, Pagoto S, Baker K, Walkosz B, Hillhouse J, Berteletti J, Bibeau J. Mutual influences of mother’s and daughter’s mental health on the closeness of their relationship: an actor-partner interdependence model. J Child Fam Stud. 2021 Mar;30:676-686.

Buller DB, Walkosz BJ, Olivas S, Eye R, Liu X, Kinsey A, Buller MK, Grayson A. Association of Occupational Sun Safety Policy and Actions in State Transportation Sector in the United States. Am J Ind Med. 2021 Apr;64(4):274-282. doi: 10.1002/ajim.23214.

Buller DB, Pagoto S, Baker K, Walkosz BJ, Hillhouse J, Henry KL, Berteletti J, Bibeau J. Results of a Social Media Campaign to Prevent Indoor Tanning by Teens: A Randomized Controlled Trial. Prev Med Rep. 2021 Apr 18;22:101382. doi: 10.1016/j.pmedr.2021.101382. eCollection 2021 Jun.

Heckman CJ, Buller DB, Stapleton JL. A call to action to eliminate indoor tanning: focus on policy [published online ahead of print April 28, 2021]. JAMA Dermatol. doi: 10.1001/jamadermatol.2021.0874.

Loeb SJ, Murphy JL, Kitt-Lewis E, Wion RK, Jerrod T, Myers VH. Inmates Care: computer-based training for geriatric and end-of-life care in prisons. J Correct Health Care. 2021 Jun;27(2):132-144. doi: 10.1089/jchc.20.03.0016.

Bourdeau B, Miller BA, Byrnes HF, Woodall WG, Buller DB, Grube JW. Efficacy of a web-based intervention (Smart Choices 4 Teens) for facilitating parent-adolescent communication about relationships and sexuality: randomized controlled trial. JMIR Pediatr Parent 2021 Jun 15;4(2):e19114. doi: 10.2196/19114.

Banerjee SC, Sussman A, Schofield E, Guest DD, Dailey YS, Schwartz MR, Buller DB, Hunley K, Kaphingst KA, Berwick M, Hay JL. “Let’s talk about skin cancer”: examining association between family communication about skin cancer, perceived risk, and sun protection behaviors. J Health Commun. 2021 Aug 3;26(8):576-585. doi: 10.1080/10810730.2021.1966686.

Riley KE, Sussman AL, Schofield E, Guest DD, Dailey YT, Schwartz MR, Buller DB, Hunley K, Kaphingst KA, Berwick M, Hay JL. Effect of superstitious beliefs and risk intuitions on genetic test decisions [published online ahead of print August 28, 2021]. Med Decis Making. doi: 10.1177/0272989X211029272.

Hay JL, Kaphingst KA, Buller D, Schofield E, Meyer White K, Sussman A, Guest D, Dailey YT, Robers E, Schwartz MR, Li Y, Hunley K, Berwick M. Behavioral and psychological outcomes associated with skin cancer genetic testing in Albuquerque primary care. Cancers (Basel). 2021 Aug 12;13(16):4053. doi: 10.3390/cancers13164053.

Woodall WG, Zimet G, Kong A, Buller D, Reither J, Chilton L, Myers V, Starling R. Vacteens.org: a mobile web app to improve HPV vaccine uptake. Front Digit Health. 25 Aug 2021;3:693688. doi: 10.3389/fdgth.2021.693688.

Doumas DM, Midgett A, Myers V, Buller MK. Usability of a technology-based bystander bullying intervention for middle school students in rural, low-income communities: mixed methods study. JMIR Form Res. 2021;5(10):e32382. doi: 10.2196/32382.

Buller DB, Pagoto S, Henry K, Berteletti J, Walkosz BJ, Bibeau J, Baker K, Hillhouse J, Arroyo KM. Human papillomavirus vaccination and social media: results in a trial with mothers of daughters aged 14-17. Front Digit Health. 2021 Sept;3:683034. doi: 10.3389/fdgth.2021.683034.

Khan E, Kaphingst KA, Meyer White K, Sussman A, Guest D, Schofield E, Dailey YT, Robers E, Schwartz MR, Li Y, Buller D, Hunley K, Berwick M, Hay JL. Comprehension of skin cancer genetic risk feedback in primary care patients [published online ahead of print November 19, 2021]. J Community Genet. doi: 10.1007/s12687-021-00566-9.

Manne S, Kashy DA, Pagoto S, Peterson SK, Heckman CJ, Gallo J, Berger A, Buller DB, Kulik A, Frederick S. Family attitudes and communication about sun protection and sun protection practices among young adult melanoma survivors and their family members [published online ahead of print November 29, 2021]. J Health Commun. 2021:1-11. doi: 10.1080/10810730.2021.2008552.

Conference Presentations

KB investigators, staff, and collaborators gave research presentations and workshops at the following virtual conferences this year:

  • 33rd Annual Scientific Sessions of the Eastern Nursing Research Society (March 2021)
  • 14th Annual Academic and Health Policy Conference on Criminal Justice Health (April 2021)
  • DC Health Communication Conference (April 2021)
  • 42nd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine (April 2021)
  • 71st Annual Conference of the International Communication Association (May 2021)
  • 5th Annual Conference of the UConn Center for mHealth and Social Media (May 2021)
  • 5th International UV and Skin Cancer Prevention Conference (September 2021)
  • Custody and Caring: 17th Biennial International Conference on the Nurse’s Role in the Criminal Justice System (November 2021)

Lastly, once the COVID-19 vaccine was widely available, a handful of long-time KB senior employees decided to make professional and personal life changes. We said farewell to Pam Stevens, the Finance Director for 15 years; Dr. Valerie Myers, a Senior Scientist for 10 years; Lucia Liu, the Biostatistical Manager for 15 years; and Adam Ashby, the Senior Developer for 15 years. They will be missed.

Family Attitudes and Communication about Sun Protection

Family Attitudes and Communication about Sun Protection

Young melanoma survivors and their families are at increased risk for developing melanoma, yet do not often practice sun protection for skin cancer prevention. Currently, little is known about the role of family interaction in sun protection.

Klein Buendel Senior Scientist, Dr. David Buller, was one of several authors on a recent paper on family attitudes and communication about sun protection among young melanoma skin cancer survivors and their family members e-published in the Journal of Health Communication. The research team was led by Dr. Sharon Manne from the Department of Medicine, Behavioral Sciences Section at the Rutgers Cancer Institute of New Jersey.

The research team set out to “examine correspondence between survivors and family sun protection, individual attitudes, and family attitudes and communication about risk-reducing behaviors, and evaluate the mediating role of family attitudes and communication in the association between individual sun protection attitudes and behavior.” Participants completed questionnaires about their individual attitudes, family attitudes and communication, and sun protection behaviors.  

Analyses showed that families had varying levels of shared attitudes and behaviors. Family discussion was associated with higher sun protection for both men and women. Other findings differed for men vs. women and cancer survivors vs. family members. Full descriptions of the measures, methods, results, and conclusions can be found in the publication. Overall, the authors believe that family-focused interventions may prove effective because families’ attitudes and practices correspond with each other.

This research was supported by a grant from the National Institutes of Health (Dr. Sharon Manne, Principal Investigator). Other authors on the publication include Dr. Deborah Kashy from Michigan State University; Dr. Sherry Pagoto from the University of Connecticut; Dr. Susan Peterson from the University of Texas MD Anderson Cancer Center; Dr. Carolyn Heckman, Joseph Gallo, Dr. Adam Berger, Alexandria Kulik, Sara Frederick, and Morgan Pesanelli from the Rutgers Cancer Institute of New Jersey; and Dr. David Buller from Klein Buendel.

Collaborator Spotlight:
Dr. Susan Loeb

Collaborator Spotlight:
Dr. Susan Loeb

Susan J. Loeb, PhD, RN, FGSA, FAAN, is a Professor in the College of Nursing and the College of Medicine at Penn State University. She earned her nursing degrees at Penn State in 1988, 1992 and 2002. She has also received numerous honors and awards, including being a Fellow of the American Academy of Nursing since 2012.

Dr. Loeb’s signature program of research focuses on addressing the health needs of older incarcerated people with chronic conditions, including those in the advanced stages of disease, and extending through their end of life (EOL). Her expertise in multiple methodological approaches is applied to a series of studies including research, development, dissemination, and implementation of a toolkit for training prison staff in strategies to enhance geriatric and EOL care in prisons. This toolkit has more recently been transformed into computer-based training modules, referred to as “Enhancing Care of the Aged and Dying in Prisons.”

She is currently a Multiple Principal Investigator with Dr. Barbara Walkosz, Klein Buendel Senior Scientist, on a study funded by the National Institute on Aging where their team is conducting research and development on a highly interactive and media-rich set of prototype modules based on best practices in peer caregiving in correctional settings. This training is referred to as “Just Care.”

Dr. Loeb and Dr. Walkosz plan to expand their research collaboration into another age-related disease area: Alzheimer’s Disease and related dementias. They hope to transform best practices in Alzheimer’s Disease and related dementias care into media-rich, highly interactive, computer-based educational modules to prepare corrections staff and peer caregivers to meet the growing care needs of people who are incarcerated and living with cognitive decline.

Dr. Loeb’s research has been disseminated through more than 50 peer-reviewed journal articles and numerous conference presentations. She has served as Principal Investigator or Multiple Principal Investigator on five studies funded by the National Institutes of Health and as Co-Investigator on two additional NIH-funded studies.


Mutual Influences of Mothers’ and Daughters’ Mental Health on the Closeness of their Relationship

Mutual Influences of Mothers’ and Daughters’ Mental Health on the Closeness of their Relationship

A Health Chat study published in the Journal of Child and Family Studies examined intra- and interpersonal associations between poor mental health and mother–daughter relationship closeness in a sample of 467 dyads. Health Chat was a social media intervention designed to reduce mothers’ permissiveness toward their teen daughters’ indoor tanning behavior. It also addressed other adolescent health topics, such as vaccination, alcohol, and physical activity.

An Actor–Partner Interdependence Model was used to examine bidirectional processes between mothers and their teenage daughters. The independent variable was self-reported poor mental health and the dependent variable was relationship closeness. Communication satisfaction was also examined as a potential interpersonal mediator of the pathway between poor mental health and relationship closeness.

Daughters’ self-reported poor mental health negatively predicted their own perception of closeness as well as mothers’ perception of closeness. In addition, there was evidence that perceived communication may help explain both the actor effect (one’s own poor mental health on one’s own perception of closeness) and the partner effect (partner’s poor mental health on one’s own perception of closeness).

Detailed methods and results are presented in the publication. Results suggest that when daughters’ mental health is poor, relationship closeness as perceived by mother and daughter may be weakened, and that this effect may in part be explained by poor communication between mother and daughter. The authors concluded that strategies to promote family communication, especially for families experiencing mental health problems, may aid in the development of closer mother–daughter relationships.

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

Keeping Research Moving During a Pandemic

Keeping Research Moving During a Pandemic

Dr. Susan Loeb, PhD, RN, FGSA, FAAN, from the Pennsylvania State University Ross and Carol Nese College of Nursing – and an active Klein Buendel research collaborator – reflected on her research team’s experience in keeping research productive during the COVID-19 pandemic at the 17th Annual Custody & Caring Conference, November 4-5, 2021. The virtual conference was sponsored by the University of Saskatchewan in Saskatoon, Saskatchewan, Canada. 

The cessation of face-to-face human subjects research by Universities and Departments of Corrections due to the COVID-19 pandemic has challenged researchers to seek alternative approaches for moving their work forward, albeit often not as originally conceived. Dr. Loeb’s presentation, and an accompanying award-winning poster led by Dr. Erin Kitt-Lewis from the Penn State Ross and Carol Nese College of Nursing, reported experiences from the Inmates Care Project,an STTR grant awarded to Klein Buendel by the National Institute on Aging (AG057239; Dr. Susan Loeb and Dr. Barbara Walkosz, Multiple Principal Investigators).

The Inmates Care study served as an exemplar to demonstrate strategies and adaptions employed to forge ahead in modified yet meaningful ways despite a protracted public health emergency. Inmates Care focuses on the research and development of computer-based training to prepare incarcerated persons to assist corrections staff in caring for people who have grown old behind bars and are approaching the end of their lives in prison. Identification of barriers and facilitators, re-envisioning how the team would restructure their day-to-day work, and preparing for the future were a few of the essential steps that were described.  

Key Lessons Learned

  • Seizing the opportunity to make investments in team member development;
  • Writing protocols that detail both in-person and virtual options for data collection to allow the team to pivot quickly when the next challenge arises; and
  • Reaching out to brainstorm with funding agency program officers, Institutional Review Board analysts, advisory board members, and other researchers beyond the team.

Such initiatives can result in scientifically sound, safe, and pragmatic solutions to keep research productive despite public health challenges. Taken together, these approaches can maintain study progress and scientific integrity, as well as identify alternate ways to achieve study aims in a timeline necessarily relaxed, but as close as possible to the original plan.

Co-authors on the presentation and 1st Place poster included Dr. Erin Kitt-Lewis, Sherif Olanrewaju, and Leigh Casey from Penn State University; Dr. Valerie Myers formerly from Klein Buendel; Jeannyfer Reither and Savanna Olivas from Klein Buendel; and Katherine Aiken from the Penn State College of Health and Human Development.

In addition to the paper and poster presentation, Dr. Loeb was also an invited panelist on a Closing Keynote titled, “Reflections on Forensic Mental Health and Correctional Nursing.”