Computer-based Learning for End-of-Life Care in Prisons

Computer-based Learning for End-of-Life Care in Prisons

In a recent publication in the Journal of Forensic Nursing, authors from The Pennsylvania State University and Klein Buendel describe, in detail, the design and development of a computer-based learning program for geriatric and end-of-life (EOL) care for incarcerated people. The program, called Enhancing Care for the Aged and Dying in Prison (ECAD-P), was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Aging.

Content creation was based on the Phase I Principal Investigators’ paper-based EOL Toolkit. The systematic design and development of the training program was guided by the Institute for Healthcare Improvement’s Framework for Going to Full Scale. The Journal of Forensic Nursing paper describes the painstaking processes of designing a program logo, recording video testimonials, creating graphic novels, incorporating visually-stimulating images, confirming reading level, and programming the functionality of the media-rich, interactive computer-based training program. The final ECAD-P program has six modules which take approximately 2.5 hours to complete in one or more sessions.

The STTR Phase I and Phase II projects were funded by a grant from the National Institute on Aging (AG049570). The Phase I Multiple Principal Investigators, Dr. Janice Penrod and Dr. Susan Loeb, are from The Pennsylvania State University. The Phase II Multiple Principal Investigators, Dr. Susan Loeb and Dr. Valerie Myers, are from The Pennsylvania State University and Klein Buendel, respectively. Other paper coauthors include Rachel Wion from The Pennsylvania State University, Tiffany Jerrod from Klein Buendel, and Sophia Strickfaden from Johnson & Wales University. ECAD-P was programmed by the Creative Team at Klein Buendel.

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.

Alcohol Sale Refusals to Pseudo-Intoxicated Patrons In Primarily Spanish-Speaking Premises

Alcohol Sale Refusals to Pseudo-Intoxicated Patrons In Primarily Spanish-Speaking Premises

Klein Buendel Senior Scientist Dr. W. Gill Woodall presented data on alcohol over-service from the WayToServe-Español project on a panel discussion at the 42nd Annual Scientific Meeting of the Research Society on Alcoholism held in Minneapolis, Minnesota on June 22-26, 2019.

The over-service of alcohol to individuals who show signs of intoxication is problematic for public health because it contributes to drunk driving and alcohol-related injury and death. In addition, little is known about alcohol over-service in premises where business is conducted primarily in Spanish because these alcohol service situations have been understudied.

Dr. Woodall presented data from a baseline assessment of a randomized trial that investigated Responsible Beverage Service (RBS) training in predominately Spanish-speaking premises in Texas and New Mexico. The research provides a unique opportunity to contrast two states and communities with similar populations, but different alcohol policies and practices.

Hispanic confederates were trained to enact evidence-based signs of intoxication while attempting to purchase an alcoholic beverage in Spanish. Over-service was measured using a pseudo-intoxicated patron protocol. Baseline refusal rates were 12% in Texas and 34% in New Mexico. On the panel, Dr. Woodall discussed the implications of these baseline data for RBS training in minority communities and alcohol policy.

This research is funded by the National Institute of Minority Health and Health Disparities at the National Institutes of Health (MD010405; Dr. W. Gill Woodall, Klein Buendel, Principal Investigator). Collaborating co-authors on the presentation included Dr. Robert Saltz from the Pacific Institute for Research and Evaluation, Dr. David Buller from Klein Buendel, Dr. Victoria Sanchez and Dr. Randall Starling from the University of New Mexico, and Dr. Areli Chacon Silva and Dr. Frank Perez from the University of Texas at El Paso.

Parenting Now Launch

Parenting Now Launch

Klein Buendel, Inc. is collaborating with Dr. Michael Hecht and his team at REAL Prevention LLC on a new research project to develop and evaluate Parenting Now, a digitized adaptation of Dr. Robert Turrisi’s parent-based teen alcohol prevention program, the Parent Handbook. The Parent Handbook is one of only two family-based interventions recommended in FACING ADDICTION IN AMERICA: The Surgeon General’s Report on Alcohol, Drugs, and Health.

In this new study, the hard copy/pdf-formatted Parent Handbook, which targets parents of college-bound youth, is being adapted for parents of high school-aged children and being programmed for interactive technology-based delivery. “Parenting Now will give parents in the digital age access to content on the go and at convenient intervals through their multiple and mobile devices,” explained Dr. Michael Hecht, the Parenting Now Project’s Principal Investigator.

The Phase II SBIR research team is (1) developing core Parenting Now modules to address essential topics such as improving communication and parent permissiveness toward adolescent drinking, (2) customizing additional topics to parents’ specific interests, and (3) personalizing the program to parents’ communication styles. “Having both core modules and optional content will allow parents to customize or click through the curriculum, a feature of digital information that makes it more engaging,” said Dr. Hecht. “Parenting Now will personalize the skills to match the parent’s existing communication style, a key feature of engaging technology.

The research project will conduct a rigorous randomized controlled trial using a nationally-representative sample through GfK Global and an active control condition. The study is evaluating Parenting Now’s effects on youth alcohol use and other substance use (marijuana use, nicotine use, and their combined use with alcohol). Researchers are examining the process of how Parenting Now influences parents’ behaviors and how these in turn influence students’ behaviors.

The Parenting Now Project is funded by the National Institute on Alcohol Abuse and Alcoholism (AA025293; Dr. Michael Hecht, REAL Prevention, Principal Investigator). Research collaborators include Dr. Anne Ray from Rutgers University and Dr. David Buller from Klein Buendel. Klein Buendel’s Creative Team is building the latest version of Parenting Now, expanding on the prototype they developed for the companion Phase I SBIR project.

Refusal of Pseudo-intoxicated Customers at Retail Marijuana Stores

Refusal of Pseudo-intoxicated Customers at Retail Marijuana Stores

Klein Buendel Senior Scientist, Dr. David Buller presented a poster at the Society for Prevention Research Annual Meeting in San Francisco, California in May. The poster presented insights on whether personnel in recreational marijuana stores refuse sales to buyers who appear to be intoxicated.

Recreational marijuana is sold by state-licensed stores in seven U.S. states. Like alcohol, sales are prohibited to persons younger than age 21 and sometimes to persons who are apparently intoxicated. A sample of 150 licensed retail stores in Colorado, Oregon, and Washington were selected from state regulatory agency lists. A majority of stores sold both recreational and medical marijuana. The sample was stratified between the largest metropolitan area in each state (Denver, Portland, and Seattle) and nearby regions with smaller cities.

Pseudo-patron assessment teams comprised of a ‘buyer’ and an ‘observer’, visited each store once from August to October 2018. Buyers attempted to enter the premises while feigning obvious signs of intoxication (for example: slurred speech, stumbling, dropped change or ID) and attempted to purchase a low-cost cannabis product. Observers recorded whether buyers gained entry and if the clerk offered to sell marijuana (no actual purchases were made).

Refusal rates were rare. Overall, refusal rates were slightly higher in the states of Colorado and Oregon than in Washington. A state law that explicitly prohibited sales in Oregon may have slightly decreased sales there, while refusals in Colorado may be attributed to the wide-scale use of security guards checking IDs at entrances. These high rates of sales to apparently intoxicated customers are a cause for concern, especially in light of research indicating that the combination of alcohol and marijuana intoxication appears to severely impair driver performance.

This research project is funded by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Additional collaborators include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in Oakland, California; and Dr. Gill Woodall and Andrew Grayson from Klein Buendel.

Nightlife Risk from Alcohol and Drug Use

Nightlife Risk from Alcohol and Drug Use

Two Klein Buendel researchers are part of a team that presented two posters at the Society for Prevention Research Annual Meeting in San Francisco in May. Dr. David Buller and Julia Berteletti are part of the Nightlife Safety Plans research team led by Dr. Brenda Miller from the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE).

Nightclubs are high-risk settings for overuse of alcohol and other drugs and physical and sexual aggression among young adults. Nightlife Safety Plans (NSP) is a group-based, tablet app-delivered intervention designed for patrons arriving together. NSP addresses these unwanted outcomes and encourages social groups to recognize early indicators of risk. Actions steps are provided via tablet app to de-escalate the situation. 

Nightclub Group Gender Composition

The first poster examined the influence of social group gender composition on alcohol outcomes and on the effectiveness of the NSP intervention across different group compositions (all-female, all-male, mixed gender). The sample included 959 nightclub patrons who formed 359 groups recruited from seven clubs, across 41 different events. Less than half of the participants were female and the average age was 26. All data was collected anonymously.

Outcome variables included overall number of the group’s safety actions taken to keep group members safe, the highest number of safety actions by any single group member, and breath alcohol concentration (BAC) at exit.  Mixed model regressions examined the main effect of group composition and its interaction with the intervention as a predictor of outcomes after controlling for individual and group characteristics. Those in the intervention condition reported higher numbers of safety actions by any single member in all female groups and mixed gender groups, but not in all-male groups. There were no significant interactions for intervention status by group composition for either BAC at exit or the number of group actions taken as assessed by the overall group.  This poster was first-authored and presented by Dr. Brenda Miller from PIRE.

Drinking Group Cohesion

The second poster examined the hypothesis that club patrons who perceive greater cohesion in their group implement fewer protective strategies and use higher levels of alcohol and other drugs. Could being part of a more cohesive peer drinking group lead to a false sense of security and letting down one’s guard, which could lead to more risk taking? The sample included 815 nightclub patrons in the San Francisco area, arriving in 324 distinct groups, from seven clubs hosting electronic music dance events across 30 different evenings. Less than half of the participants were female and the average age was 27. Club patrons were surveyed anonymously and completed breath tests as they entered and exited clubs. Oral fluid samples at exit assessed drug use.

Patrons reported perceived cohesion with their group members (for example, people in the group are willing to help each other), as well as use of actions to keep oneself safe, actions to keep group members safe, and actions in response to group alcohol and other drug problems. Mixed model regressions examined group cohesion as a predictor after controlling for individual and group characteristics, and past 30-day drinking/drug use at clubs. Findings partially confirm the hypothesis. Patrons who perceived greater group cohesion engaged in fewer preventive strategies to keep themselves and their group safe during the night and those who perceived greater group cohesion implemented fewer actions in response to group AOD problems. This poster was first-authored and presented by Dr. Hilary Byrnes from PIRE.

The NSP research is funded by a grant to the Prevention Research Center at PIRE from the National Institute on Alcohol Abuse and Alcoholism (AA022331; Dr. Brenda Miller, Principal Investigator). Research team collaborators/authors include Dr. Brenda Miller, Dr. Hilary Byrnes, Dr. Joel Grube, and Dr. Beth Bourdeau, Dr. Mark Johnson, and Veronica Rogers from PIRE; and Dr. David Buller and Julia Berteletti from Klein Buendel. The NSP tablet app was developed by Klein Buendel’s Creative Team.

Collaborator Spotlight:
Dr. Robert Newton

Collaborator Spotlight:
Dr. Robert Newton

Robert Newton, Jr., Ph.D., is an Associate Professor in the Physical Activity and Ethnic Minority Health Laboratory at Pennington Biomedical Research Center (PBRC) at Louisiana State University. He has collaborated with Dr. Valerie Myers for several years – most recently on the Healthy Detours project funded by the U.S. Centers for Disease Control and Prevention and the MobileMen project funded by the National Institute on Minority Health and Health Disparities.

In Phase I of the MobileMen project, a prototype mobile app to track physical activity, tailored to African American men ages 18 to 45, was developed. The goal was to help African American men in the maintenance phase of physical activity to remain actively physically active. Currently, Dr. Newton and Dr. Myers are working on funding for Phase II of MobileMen. In Phase II, all features of the full mobile app will be programmed and evaluated with the target population.

More broadly, Dr. Newton’s research addresses health disparities experienced by the African American community. Much of his work addresses the design and development of physical activity interventions and he also conducts weight loss research. He develops community-based and technologically-driven interventions to promote physical activity, weight management, and weight loss among African American adolescents, adults, and older adults.

Currently, Dr. Newton leads studies assessing the effect of a community-based physical activity intervention in older African American adults and a mobile phone-based intervention targeting increased physical activity in young children. He is also involved in two primary care weight management programs and several childhood physical activity and/or weight management studies.

Dr. Newton has a Ph.D. in Clinical Psychology from the University of Florida. Outside of his work at PBRC, Dr. Newton is the Healthy Equity Special Interest Group Chair for the Society of Behavioral Medicine and is a member of the American College of Sports Medicine.

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.


  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.
  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.
Sun Safety Ink! Expands to the Latino Community

Sun Safety Ink! Expands to the Latino Community

Skin cancer rates continue to rise in the Hispanic population. In the last two decades, their annual melanoma incidence has increased by 20% (5). Even though Hispanics are diagnosed at a disproportionately lower level than non-Hispanic whites (NHWs), they are diagnosed with melanoma at a younger age, with a more advanced stage of the disease, and have lower melanoma-specific survival rates than NHWs (1,3).

Klein Buendel’s randomized controlled trial, Sun Safety Ink!, trains tattoo artists to offer skin cancer prevention advice to their clients. A recent diversity supplement will extend the Sun Safety Ink! study by focusing on how this information can be targeted to Hispanic tattoo artists and their clients, especially young adults. The supplement’s goals are to discover new approaches to address the increasing rates of skin cancer in the Hispanic population and to provide insight into the implementation of skin cancer prevention in an often hard-to-reach population.

Over 30% of the Hispanic population has tattoos (4), a rate that is higher than NHWs (25%). Tattoo studios, because they often recommend sun protection in their aftercare instructions, are a unique context in which to promote full body sun protection to Latinos. Sun Safety Ink! will distribute sun safety information to hard-to-reach Hispanic young adults. The diversification of the study sample will provide information on (1) baseline knowledge on sun protection in the Latino population, (2) barriers to sun protection, and (3) at-risk populations.

The supplement includes both formative research and the implementation of the Sun Safety Ink! program. Specifically, tattoo studios with Hispanic artists and clients in Utah, Colorado, Arizona, and New Mexico will be recruited to participate in the study. The tattoo artists will be provided with a version of the Sun Safety Ink! training modified based on formative research conducted by Cristian Gonzalez, MD. Dr. Gonzalez is a Research Fellow at the University of Colorado Anschutz Medical Campus and an upcoming Medical Resident at the University of Texas Southwestern Medical Center.

Dr. Gonzalez explained that the most important aspect of this project is that “Latinos have this invincibility factor that they think they can’t get skin cancer because they don’t know a lot of family members or friends with skin cancer, so sometimes it really doesn’t come up. If we can increase awareness of skin cancer in the Latino community, and if we can also improve sun protection behavior, I think we would see a reduction in melanoma and non-melanoma skin cancer in the future.”

Sun Safety Ink! is funded by a grant and a supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz, Principal Investigator). Collaborators include Dr. David Buller, Mary Buller, Rachel Eye, and Savanna Olivas from Klein Buendel; and Dr. Robert Dellavalle from the University of Colorado, Denver.

Dr. Cristian Gonzalez


  1. Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Natale-Pereira A, Goydos JS. Sun protection and exposure behaviors among Hispanic adults in the United States: differences according to acculturation and among Hispanic subgroups. BMC Public Health. 2012;12:985.
  2. Hay J, Coups EJ, Ford J, DiBonaventura M. Exposure to mass media health information, skin cancer beliefs, and sun protection behaviors in a United States probability sample. Journal of the American Academy of Dermatology. 2009;61(5):783-792. doi: 10.1016/j.jaad.2009.04.023.PMC2854488
  3. Harvey VM, Oldfield CW, Chen JT, Eschbach K. Melanoma disparities among US Hispanics: use of the social ecological model to contextualize reasons for inequitable outcomes and frame a research agenda. Journal of Skin Cancer. 2016;2016:4635740. doi: 10.1155/2016/4635740
  4. One in five U.S. adults now has a tattoo [press release]. New York, NY: Harris Insights & Analytics, February 23. Available at:
  5. Skin cancer rates soar in US Hispanics. Sun & Skin News. November 21, 2013;30(4).
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.