Cost of Occupational Sun Protection Policy Intervention Delivery

Cost of Occupational Sun Protection Policy Intervention Delivery

Dr. Richard Meenan presented cost analysis data from the Sun Safe Workplaces project at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focused on an estimated cost of delivering a sun protection policy intervention to public-sector employers in Colorado. The cost of occupational skin cancer prevention interventions poses challenges for organizations delivering interventions and employers that implement sun protection for outdoor workers.

The Sun Safe Workplaces (SSW) intervention promoted occupational sun protection policies and education to 98 public-sector employers in a randomized controlled trial. Intervention components included in-person meetings and follow-up contact by email and telephone with senior managers, in-person trainings for employees, and printed educational materials sent to the workplace. Using a micro-costing approach, costs to the intervening organization were determined from the project accounting system supplemented by external sources. Costs to employers were estimated from responses to semi-structured interviews in a two-year follow-up with 34 senior managers on implementing sun protection education and other actions to support employee sun safety and were presented at the conference. Employers incurred highest average costs for implementing onsite sun safety training, primarily the estimated value of employee time in attendance.

Costs to employers are likely a barrier to acting on skin cancer prevention. In the SSW trial, employers appeared to incur more costs than the intervening organization. Strategies to control employer costs should be considered when designing occupational skin cancer prevention interventions. Costs will be used to determine: (1) the incremental cost of the SSW intervention (ignoring development and research costs) and (2) the incremental cost of the employers’ skin cancer prevention education and policy adoption actions induced by the SSW intervention.

This research was funded by a grant from the National Cancer Institute (RO1CA187191; Dr. David Buller, Klein Buendel, Principal Investigator). Collaborators include Dr. Barbara Walkosz, Rachel Eye, and Mary Buller from Klein Buendel; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; and Dr. Allan Wallis from the University of Colorado Denver.

Klein Buendel was one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Sun Safety Ink!

Sun Safety Ink!

Dr. Robert Dellavalle presented Sun Safety Ink! at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focused on formative research conducted by Klein Buendel and the University of Colorado Denver to develop a skin cancer prevention training program for tattoo artists.

Twenty-five percent (25%) of American adults have a tattoo, and higher rates are found among younger generations. Sun safety promotions to young adults are significant because risk factors are elevated for this population. Tattoo artists may be ideal sources for delivering effective sun safety interventions to this hard-to-reach, at-risk population because sun safety is recommended for tattoo aftercare and the long-term.

Semi-structured interviews with tattoo artists and focus groups with tattooed individuals gathered input on the design of the Sun Safety Ink! (SSI!) online training program for tattoo artists. Tattoo artists had limited knowledge of skin cancer but reported that they alert clients if they observe skin abnormalities. All artists provided written and verbal aftercare instructions that included sun safety recommendations, but only for tattoos. Artists were interested in the SSI! training program. They suggested the use of video training scenarios to help artists learn to communicate with clients and that information about skin cancer (such as statistics and causes), conversation starters, and examples of sun safety practices be included.

Focus group participants had low levels of sun protection. Participants reported most artists do not discuss health topics but were positive about receiving skin cancer prevention messages, especially during lengthy tattoo sessions. Participants noted that sun safety advice from an artist might make a difference in protecting all of their skin not just tattoos. They recommended that artist deliver sun protection information multiple times while the client is getting the tattoo, during follow-up visits, by text message, in aftercare instructions with pictures or skin cancer facts, and via social media.

Both artists and clients were supportive of SSI! Artists are viewed as a trusted source of information and have the potential to impact clients’ sun safety practices. Suggestions regarding training content and format will be incorporated into an online training for tattoo artists.

This research was funded by a grant from the National Cancer Institute (R01CA206569; Dr. Barbara Walkosz, Klein Buendel, Principal Investigator). Collaborators include Dr. David Buller, Mary Buller, Rachel Eye, and Savanna Olivas from Klein Buendel; and Dr. Dellavalle from the University of Colorado, Denver.

Klein Buendel was one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Costs of Sun Safety Policy Implementation in California Elementary Schools

Costs of Sun Safety Policy Implementation in California Elementary Schools

Dr. Richard Meenan is presenting cost analysis data from the Sun Safe Schools project at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focuses on the estimated costs of delivering a sun protection policy intervention to public elementary schools in California.

Implementation of sun safety practices is an important element of efforts by elementary schools to prevent skin cancer among their students. However, cost can significantly impede such implementation. The Sun Safe Schools (SSS) trial provided technical assistance to 118 California public elementary schools interested in implementing sun safety practices consistent with district policy. Intervention components were primarily an initial intervention meeting with school administrators, and follow-up email and telephone communications. Schools chose from 47 possible practices to implement.

Using a micro-costing approach, intervention delivery costs to the intervening organization were determined from the project tracking database supplemented by external sources. Labor and non-labor practice costs incurred by schools were estimated using a project template, which three authors reviewed for reasonableness. The 47 practice codes were collapsed into ten categories, such as outdoor shade and parent outreach. The 58 intervention schools implemented a total of 128 practices. Thirty-seven schools implemented at least one practice. Most common practices were parent outreach, education of students, and teacher training. Data on the average cost of participating in the school-based sun safety intervention will be presented at the conference.

In summary, costs to schools may hinder action on implementation, so cost control strategies should be considered when designing school-based sun safety interventions. Next steps are to determine: (1) the incremental implementation cost of the SSS intervention and (2) the incremental cost of the schools’ sun safety education and policy adoption actions induced by SSS.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (R01HD074416; Dr. Kim Reynolds, Claremont Graduate University, Principal Investigator). Collaborators include Kim Massie from Claremont Graduate University in California; Dr. David Buller, Julia Berteletti, and Mary Buller from Klein Buendel; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; and Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California.

Klein Buendel is one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Sun Safe Schools Program Implementation

Sun Safe Schools Program Implementation

Ms. Kim Massie is presenting a poster on the implementation of the Sun Safe Schools project at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada, May 1-4, 2018. The poster focuses on the delivery of a sun protection policy intervention to public elementary schools in California.

The U.S. Surgeon General’s Call to Action to Prevent Skin Cancer in 2014 emphasized the importance of sun safety for schools; however, there is limited information on how to effectively assist schools in implementing sun safety. The Sun Safe Schools project was developed to provide technical assistance to 118 public elementary schools in California with the implementation of sun safety practices consistent with district board policy for sun protection (BP 5141.7). A trained coach worked with principals to select sun safety practices within policy categories, such as education of students and parent outreach, and develop their implementation plan. The coach recorded all reported intervention activities within a tracking database including practice selection date, policy category, practice description, and implementation date.

A variety of practices, such as posting the UV Index and providing sunscreen, were implemented at 58 intervention schools. Practices were predominately implemented in the first 12 months of the 20-month program. Most practices were implemented in the spring. Low periods of implementation coincided with summer and winter breaks in the school calendar. The most frequently implemented practices included distributing sun safety information to parents, arranging sun safety presentations for students, and providing a sun safety webinar to staff. Policy categories most frequently implemented included education of students, parent outreach, and education of teachers.

Overall, working with schools presents unique challenges for implementation of sun safety. To be effective, implementation assistance should be designed around the school calendar and allow the principal to determine the pace and priorities.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (R01HD074416; Dr. Kim Reynolds, Claremont Graduate University, Principal Investigator). Collaborators include Kim Massie and Brianne Freeth from Claremont Graduate University in California; Dr. David Buller, Julia Berteletti, and Mary Buller from Klein Buendel; and Dr. Jeff Ashley from Sun Safety for Kids, Inc. in Los Angeles, California.

Klein Buendel is one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

 

Methodological Challenges of Social Media-Delivered Health Promotion Interventions

Methodological Challenges of Social Media-Delivered Health Promotion Interventions

Dr. Sherry Pagoto, SBM President-elect and KB Collaborator, was a co-presenter for a Behavioral Informatics and Technology Panel Discussion on social media health promotion at the 39th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine, April 11-14, 2018 in New Orleans, Louisiana. Dr. Pagoto shared methodological challenges related to participant recruitment, intervention content development, and intervention delivery for a Facebook intervention targeting mothers of teen daughters in order to reduce the incidence of indoor tanning. This project is currently being conducted by KB and several collaborators from the University of Connecticut, East Tennesee State University, and Colorado State University.

Social media platforms can be used to deliver health promotion interventions to wide audiences without the barriers that plague traditionally-delivered programs, such as geography, transportation, scheduling, and childcare. Because most people access their social media feeds daily, health programming can be delivered to populations who are not necessarily seeking help or are motivated to change. Despite these promising and unique features, designing studies to evaluate social media-delivered interventions involves methodological challenges for recruitment and participation. During the panel discussion, Dr. Pagoto shared some of our research project’s challenges, implications of alternative recruitment and engagement methods, and valuable lessons learned.

This research project is called “Likes Pins and Views: Engaging Moms on Teen Indoor Tanning Thru Social Media.” It is funded by a grant from the National Cancer Institute (RO1CA192652; Dr. David Buller, KB, Principal Investigator). Collaborators include Dr. Barbara Walkosz and Julia Berteletti from KB, Dr. Sherry Pagoto, Jessica Oleski, and Ashley Panzarino from the University of Connecticut, Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University, and Dr. Kim Henry from Colorado State University.

Insights on Computer-Based End-of-Life Training in Prisons

Insights on Computer-Based End-of-Life Training in Prisons

Dr. Valerie Myers, KB Senior Scientist and SBM Fellow, presented a poster on the Enhancing Care of the Aged and Dying in Prison project at the 39th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM), April 11-14, 2018 in New Orleans, Louisiana.

The prison population is aging at a rapid rate and is expected to continue to do so into the foreseeable future. As a result, prisons in the United States are facing increased demands in caring for aged, chronically ill, and dying inmates. Despite advances in the free world, best practices for managing geriatric issues and life-limiting or terminal illness have not been adapted for use in corrections settings. Implementing a training program addressing the health issues related to this population could mitigate legal risks and enhance care. However, the paramount focus on security makes technological advances available in the free word inaccessible inside prison walls.

Lessons learned from prior development, implementation, and evaluation research targeted at enhancing care for the aged and dying in prison led to the development of a media-rich interactive computer-based learning prototype, Enhancing Care of the Aged and Dying in Prison (ECAD-P). ECAD-P contains six modules that address end-of-life and geriatric care issues in prisons. The purpose of this aim of the project focused on a small-scale evaluation of ECAD-P. Specifically, in-person usability testing was conducted at one state department of corrections and one large city jail. Twelve participants evaluated the user interface, ease of use, and perceived barriers of the prototype, so that the research team may further understand user preferences, optimize the learning modules, and prepare for implementation.

A summary evaluation of the computer-based prototype training includes the participants’ impressions regarding the user interface of the computer-based training modules, beliefs about ease of use of the computer-based training modules, perceived barriers regarding the use of the computer-based training modules. Findings will be used to refine the computer-based training modules for large-scale usability testing targeting 12 prisons and jails across the United States. Lessons learned from this usability study and the larger scale usability study will inform future dissemination of the product. The intent of this educational product is to extend our reach to promote quality of health and health equity, as well as narrow the gap in health disparities experienced by a group that has often been described as “the least among us.”

This research project is funded by a grant from the National Institute on Aging (AG049570; Dr. Janice Penrod, Penn State University, Principal Investigator). Collaborators included Dr. Valerie Myers, Sophia Strickfaden, and Tiffany Jerrod from Klein Buendel, and Dr. Susan Loeb, Dr. Erin Kitt-Lewis, and Rachel Wion from the Penn State University College of Nursing.

KB and Canada Host World’s Sun Safety Experts

KB and Canada Host World’s Sun Safety Experts

How can sun safety messages convince travelers to seek shade and cover up in the sun on vacation? How can the built environment help increase sun safety by maximizing access to shady areas? How can the use of Big Data drive people to be more “sun smart”?

These and many other issues will be front and center at the 4th International Conference on UV and Skin Cancer Prevention at Ryerson University in Toronto, May 1-4. Held in different countries around the world – the 2015 event was in Sydney, Australia – the International Conference on UV and Skin Cancer Prevention highlights the best in public health and community-based approaches to educating the public about the importance of UV protection.

“This fourth conference really aims to disrupt current ways of thinking in the field of skin cancer prevention by sparking new ideas, proposing new intersections between disciplines, and fostering new connections and collaborations,” said Ms. Mary Buller, conference organizer and Owner and President of Klein Buendel, a Golden, Colorado-based health communication research company whose investigators have been conducting skin cancer prevention research since the early 1990s.

While preventing skin cancer is the galvanizing theme of the conference, sessions cover topics ranging from urban planning, architectural design, public health and radiation science. The common goal is to increase public awareness – and public action – on the need for increasing shade and maximizing sun protection, not just during leisure pursuits, but also in the workplace.

“The sun is a workplace hazard that can cause skin cancer, heat stress and eye damage, yet these conditions are preventable with an increase in awareness,” said Dr. Thomas Tenkate, conference organizer and Director of the School of Occupational and Public Health at Ryerson University.

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Sun Safety Policy at Work and School

Sun Safety Policy at Work and School

KB scientists, research staff, and collaborators are presenting research findings at the 39th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine, April 11-14, 2018 in New Orleans, Louisiana. One presentation and one poster address sun protection and skin cancer prevention policy in workplaces and schools:

Moderators of Implementation of Occupational Sun Protection Policy

Outdoor workers are at high risk for skin cancer. Dr. David Buller, KB Director of Research and SBM Fellow, is giving a presentation on the Sun Safe Workplaces Project. In this study, organizational and employee characteristics were examined as moderators of implementation of occupational sun protection policy. Public employers (n=98) in Colorado participated in a randomized controlled trial evaluating the Sun Safe Workplaces (SSW) intervention. Based on Diffusion of Innovations Theory, project staff promoted sun safety policy adoption and trained workers in sun protection. Line supervisors (n=3,650) and workers (n=1,555) completed a two-year follow-up survey at 68 employers. Among other findings, greater communication with employees occurred by employers with a policy than without one. The research was funded by a grant from the National Cancer Institute (R01CA134705; Dr. David Buller, PI). Dr. Barbara Walkosz, Mary Buller, and Lucia Liu from KB participated on the research team. Additional collaborators include Dr. Allan Wallis from the University of Colorado, Denver, and Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon.

Correlates of Sun Safe Policy Implementation Among Elementary Schools

In 2014, the U.S. Surgeon General issued a Call to Action to Prevent Skin Cancer, citing its high and increasing prevalence and cost. The Centers for Disease Control and Prevention and the Surgeon General identified sun safety in schools as a priority to reduce UV exposure and sunburns of children, with school district policy a key aspect of school-based efforts to prevent skin cancer. Dr. Kim Reynolds, KB Collaborator from Claremont Graduate University (CGU), is presenting a poster on the Sun Safe Schools Project.  This study explored correlates of the implementation of sun-safe practices, consistent with district board policy, among principals and teachers in public elementary schools. The sample included elementary school principals (N=118) and teachers (N=113) recruited from 40 California public school districts that had adopted Board Policy 5141.7 for sun safety and posted it online. Principals and teachers from the elementary schools reported on student sun protection policies and practices when surveyed. The study looked at the number of practices implemented consistent with California Senate Bill 1632 (Billy’s Bill), which protects the right of students to apply sunscreen at school without a physician note and to wear UV-protective clothing including hats on school grounds. Improved awareness of the existence and content of district board policy for sun safety may increase implementation of school skin cancer prevention.

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 (R01HD074416; Dr. Kim Reynolds, CGU, and Dr. David Buller, KB, PIs). Collaborators included Julia Berteletti and Mary Buller form KB, Kim Massie from CGU, Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California and Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon.

Designing a Web App to Promote Teen Vaccination Uptake

Designing a Web App to Promote Teen Vaccination Uptake

Ms. Julia Berteletti, KB Research Program Manager, is presenting a poster on formative research from the BeVaccinated Project at the 39th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine, April 11-14, 2018 in New Orleans, Louisiana.

While vaccination rates for young children in the United States currently meet recommended standards, the Centers for Disease Control and Prevention reports adolescent vaccines uptake to be less than optimal, and in the case of the Human Papillomavirus (HPV) vaccine, seriously below desired uptake levels. To address this deficit, a web-browser application prototype, BeVaccinated, was developed to test reactions to and feasibility of delivering adolescent vaccine information via smartphone. The BeVaccinated app prototype was developed from formative research with 26 focus group participants and guided by an Expert Advisory Board comprised of vaccination experts and clinicians.

Usability testing on one module, about deciding to vaccinate, was conducted iteratively with nine parent and teen pairs in New Mexico and seven parent and teen pairs in Colorado. Pairs were comprised of one teen (ages 13-17) and their accompanying parent or guardian. Usability testing was conducted individually with the parent and teen by trained research staff. During the testing, participants used the app prototype, answering questions as prompted. At the conclusion of testing, participants completed the 10-item Bangor System Usability Scale (SUS). Parents and teens rated the app as very easy to use. SUS data also indicated that participants could quickly learn to use the app and that they would be confident using it.

A Specifications Document outlines the planned design of the full-scale app based on testing results. Findings included in the specifications document are: 1) provide tailored learning experiences to teens (i.e., game-based) and parents (i.e., didactic) within the same app; 2) integrate individualized information (e.g., clinic preferences); and 3) provide a vaccination record tracking feature. The planned app could improve dissemination of vaccine information, enhance parent/teen communication around health behavior choices, and ultimately, improve the uptake of vaccinations.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R41HD082901; Dr. Gill Woodall, KB Senior Scientist, PI) Research collaborators included Dr. Randall Starling and Dr. Lance Chilton from the University of New Mexico, Dr. Gregory Zimet from Indiana University, Dr. Nathan Stupiansky from the University of Arizona, and Sophia Strickfaden from KB.

Precision Pain Management App for Adolescents with Sickle Cell Disease

Precision Pain Management App for Adolescents with Sickle Cell Disease

Dr. Valerie Myers, KB Senior Scientist, is presenting a poster on the Pinpoint Project at the 39th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine, April 11-14, 2018 in New Orleans, Louisiana.

Pinpoint: Gaming Technology to Engage Adolescent Sickle Cell Patients in Precision Pain Management” was a Phase I SBIR project that examined the feasibility and acceptability of a gamified tablet application intended to encourage teens (aged 13-17) to assess and talk about their sickle cell disease (SCD) pain. SCD is the most common inherited blood disorder in the U.S. and affects primarily African Americans and Hispanics. Approximately, 1,000 U.S. children are born with SCD annually. SCD complications can be serious and have a significant impact on well-being and quality of life.

Pain is the hallmark symptom associated with SCD and is the primary cause of SCD-related hospital admissions. Accurate assessment of pain specifiers (type, frequency, and intensity of pain) can help with ameliorating pain quickly and effectively. Reducing barriers to collection and promoting the value of accurate SCD pain assessment is a need in pediatric medicine. The interactive games for health literacy among youths have shown video games can improve self-efficacy; stimulate health discussions with friends, family, and clinical team; encourage seeking support and advice, and can emphasize behavior acquisition via experiential learning. Interactive games can provide information about causes, treatments, and self-care options, and can improve self-care and reduced emergency clinical utilization.

The Pinpoint app prototype for tablets and smartphones consisted of a Pain Assessment Tool, vocabulary game, body scanner reflection, educational self-disclosure activity, and excerpts from the Hope and Destiny Jr. book authored by Hsu, Rodrigues, and Brandalise. Four healthcare providers were interviewed on the app’s acceptability and potential function within the clinical practice. Sixteen teens participated in cognitive interviews, focus groups, and usability testing. The System Usability Scale (SUS), a validated tool for assessing the usability and acceptability of technological products, served as the primary outcome. The preliminary SUS score well above average, suggesting a high level of acceptability and usability among users. The conference poster will include final project outcomes and the plan for the future development of the full Pinpoint app.

This research was funded by a grant from the National Institute on Minority Health and Health Disparities (R43MD010746; Dr. Valerie Myers, PI). Research collaborators included Mary Buller from KB, and Dr. Hilton Hudson and Megan Lippert from the Hilton Publishing Company, publishers of the Hope & Destiny and Hope & Destiny Jr. sickle cell disease management books.