Uptake of MC1R Testing for Melanoma Risk

Uptake of MC1R Testing for Melanoma Risk

The use of personalized medicine or tailoring medicine based on sequencing and analyzing an individual’s DNA, is drastically changing cancer research and treatment, risk assessment and clinical practices1, and skin cancer is one area being affected by this research.2 Currently, melanoma in U.S. Hispanic populations is on the rise and despite melanoma being more common in Caucasians than Hispanics, a melanoma diagnosis is more likely to be fatal for Hispanics.3

In a study recently published in JAMA Dermatology, several researchers (lead author Dr. Jennifer Hay) including Dr. David Buller from Klein Buendel, examined interest and uptake, as well as demographic and skin cancer risk factor covariates of interest and uptake, of the melanocortin-1 receptor gene (MC1R) saliva test among 499 adult participants recruited from diverse clinics in Albuquerque, New Mexico. Forty-four percent (44%) of participants were non-Hispanic white, 48% were Hispanic, and all were registered clinic patients for longer than six months, were 18-years of age or older, and spoke English or Spanish fluently. A study website log-in was given to participants to give them the option to log on and read three educational modules presenting the rationale and pros and cons of MC1R testing.

Results showed that almost 50% (n=232) of participants logged on to the website and that non-Hispanic whites and those with higher education were more likely to do so. Furthermore, participants with a history of sunburn and with at least one first-degree relative were also more likely to log on to the website. Of those who logged on, almost 90% (n=204) decided to request testing and a little over 80% (n=167) of those who requested testing returned the kit. Non-Hispanic whites and older participants had a higher rate of returning the kit.

Authors cite the large, diverse sample and the behavioral outcomes versus self-reported outcomes as strengths of the study while citing the single location and use of one primary care health system for recruitment as a limitation on generalizability. Lastly, authors conclude by calling for future research in socioeconomic and demographic discrepancies in interest and uptake of genetic testing in order to ensure ease of availability of genetic information seeking in the general population.


  1. Orchard C. Genomic medicine in the real world: “hope” and “hype”. Harvard T.H. Chan School of Public Health Web site. Available at: https://www.hsph.harvard.edu/ecpe/genomic-medicine-in-the-real-world-hope-and-hype/. Published June 1, 2015. Accessed June 20, 2018.
  2. Genetics of skin cancer (PDQ) – health professional version: genetic testing. National Cancer Institute Web site. Available at: https://www.cancer.gov/types/skin/hp/skin-genetics-pdq#link/_393_toc. Updated June 14, 2018. Accessed June 20, 2018.
  3. Perez MI. Hispanics get skin cancer, too. Skin Cancer Foundation Web site. Available at: https://www.skincancer.org/prevention/are-you-at-risk/hispanic. Published May 25, 2016. Accessed June 20, 2018.
Online Responsible Alcohol Beverage Server Training for Spanish Language Populations

Online Responsible Alcohol Beverage Server Training for Spanish Language Populations

Data from a Klein Buendel (KB) research project on the formative development of an online responsible alcohol beverage server training program for Spanish language populations the U.S. Southwest was presented in June at the 41st Annual Scientific Meeting of the Research Society on Alcoholism in San Diego, California.

Preventing alcohol-related injury and death is a national priority. Evidence-based interventions to change organizational and community norms, including training to promote responsible alcohol beverage service (RBS), are important public health approaches. However, current RBS training has not been tailored to address Spanish-speaking populations that represent disproportionately high rates of alcohol-related injury and death in the U.S. WayToServe®, an evidence-based RBS intervention, is being redesigned to promote a culturally and linguistically adapted RBS training for Spanish-speaking servers, titled WayToServe Español.

Four focus groups were conducted with Spanish-speaking alcohol servers to identify linguistic and culturally relevant additions to create WayToServe Español. Focus groups were held in El Paso, Texas, on weekdays in spring 2017, between 1:30-3:00 pm. Of the 37 participants, all were either monolingual or bilingual Spanish-speakers and active or recent alcohol sellers/servers. Research team members conducted the groups. The discussions were audiotaped and transcribed verbatim from Spanish to English. Two team members reviewed all transcripts for recurring ideas and comments and then categorized them into main themes.

Preliminary analysis identified four overarching themes: (1) challenges faced by servers, such as setting clear limits for alcohol service for their patrons; (2) support for RBS training; (3) participants’ evaluations of previous training (for example, the low quality of existing Spanish-language RBS training; and (4) their recommendations for Spanish-language RBS training, such as the importance of culturally-respectful training. Participants noted easy access to the web-based RBS training. Overall, the data suggest that WayToServe Español for Spanish-speaking servers is an important step in the creation of culturally- and linguistically-relevant approaches to enhance RBS.

This research project is titled “WayToServe Español: A Culturally-Appropriate Online Responsible Beverage Service Training for Spanish-Speaking Servers” and is funded by the National Institute of Minority Health and Health Disparities at the National Institutes of Health (R44MD010405. Dr. W. Gill Woodall, a KB Senior Scientist, is the project’s Principal Investigator. Collaborating co-authors on this presentation included Dr. Victoria Sanchez from the University of New Mexico Health Sciences Center, Dr. Areli Chacon Silva and Dr. Frank Perez from the University of Texas at El Paso, and Ms. Jeanny Camacho Reither, KB Senior Project Coordinator.

Interdisciplinary Perspectives on Sun Safety

Interdisciplinary Perspectives on Sun Safety

Skin cancer is the most common cancer in the United States, with more than 5 million new cases diagnosed per year.1 As part of an effort to reduce incidence and mortality from skin cancer, the National Academy of Sciences hosted 19 experts from a variety of healthcare fields (including dermatology, behavioral medicine, public health, adolescent medicine, clinical health psychology, anthropology, and kinesiology). The experts, including Klein Buendel’s Director of Research, Dr. David Buller, met for two days in December 2016 to identify emerging themes in skin cancer prevention and control.

The report of this interdisciplinary collaboration and its five main culminating themes were published in JAMA Dermatology, a monthly peer-reviewed medical journal published by the American Medical Association.

The Emerging Themes for Skin Cancer Prevention and Control

  1. Expanding the definition of risk in order to better tailor sun safety programs, create guidelines that acknowledge the beneficial effects of ultraviolet radiation (UVR) exposure and develop strategies that involve those from diverse backgrounds (e.g. lower socioeconomic status, those with darker skin).
  2. Intertwining sun protection strategies and messages with other health-related strategies and messages, such as physical activity recommendations, in order to prevent increasing a person’s risk for one disease despite decreasing it for another.
  3. Tailoring sun safety messages using multiple components (e.g. place, weather, personal values, individual risk factors and motivations) to better persuade individual behavior change through novel channels such as smartphones and social media platforms.
  4. Recognizing excessive tanning as an addiction in order to enable proper education for clinicians to give a diagnosis and create more effective treatments, including the possibility for pharmacological treatments.
  5. Scaling up evidence-based interventions to increase the impact and achieve population-level skin cancer prevention through identifying the most appropriate dissemination and implementation methods that are also cost-effective, wide-reaching and lead to behavior change.

Authors, including Dr. Buller, conclude by stating that future expert meetings should focus on sun protection in the pediatric population and that future research to address these themes will need to be interdisciplinary to decrease the burden of skin cancer.


  1. American Cancer Society. Cancer Facts & Figures 2018. Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf. 2018. Accessed June 11, 2018.
Collaborator Spotlight:
Dr. Victoria Sánchez

Collaborator Spotlight:
Dr. Victoria Sánchez

Dr. Victoria Sánchez is an Associate Professor in the College of Population Health at the University of New Mexico (UNM) in Albuquerque.  She earned her MPH at the University of California at Berkeley and her Doctorate in Public Health (DrPH) in Health Behavior and Health Education at the University of North Carolina at Chapel Hill.  She directs the MPH Community Health Concentration track at UNM and teaches social and behavioral sciences courses for the UNM College of Public Health.

Dr. Sánchez has a long-standing commitment to participatory planning and evaluation processes with communities and public health organizations. Over the last thirty years, she has integrated her expertise in public health practice and participatory and multidisciplinary research methodologies to plan and implement joint solutions for reducing health and social disparities in Latino and other vulnerable communities. As a member of multidisciplinary teams, she has applied social and cultural theories and models in the development, tailoring, testing, and evaluation of interventions to improve the health of Latinos/Hispanics in New Mexico, Texas, and California.

Currently, Dr. Sánchez is working with Klein Buendel as a collaborating scientist with Dr. Gill Woodall and Dr. David Buller on WayToServe Español: A Culturally-Appropriate Online Responsible Beverage Service Training for Spanish-Speaking Servers (R44MD010405; Dr. Gill Woodall, Principal Investigator). This research project is funded by the National Institute on Minority Health and Health Disparities. Dr. Sánchez collaborates on the creation and evaluation of culturally-appropriate content and the translation of the English WayToServe® online training program to Spanish. She helps ensure that the translation is compatible with the values and needs of servers in Spanish language-dominant bars and restaurants. The randomized control trial is being conducted at Spanish-dominant businesses in the Southwestern region of the United States.

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Skin Cancer Prevention Messages on Facebook

Skin Cancer Prevention Messages on Facebook

Social media use among American adults has grown over the years – from just 5-in-10 in 2011 to seven-in-ten in 2018 – and reasons for using social media range from connecting with others to accessing news content to sharing information.1 With skin cancer still the most common among all cancers,2 it seems logical to use social media to promote and spread skin cancer prevention awareness. But is it effective?

In a recently published article in the Journal of the American Academy of Dermatology, KB’s Dr. Barbara Walkosz and Rachel Eye, along with other collaborators, aimed to review and classify skin cancer prevention messages from non-profit organizations on Facebook to determine which types garnered high engagement, such as likes, comments, and shares. Messages were identified using the following keywords: “skin cancer prevention,” “melanoma,” “melanoma prevention,” and “sun safety.” From May 2014 to May 2015, Facebook pages of 24 skin cancer groups’ and their 824 Facebook messages were coded for the following content: message format (narrative or didactic), motivation (skin cancer risk or appearance), persuasive appeal (social norm, fear, humor, altruism, celebrity story), behavioral target (sunscreen, hats, shade, avoid sunburn, indoor or outdoor tanning, skin exams), imagery, image content, and hyperlink. Engagement and frequency of message types were also determined.

Authors found that the majority of messages were didactic and focused on skin cancer occurrence and type but note that these approaches are not always effective in producing behavior change. Furthermore, the top three behavioral targets addressed were skin exams, indoor and outdoor tanning, and sunscreen use. Messages that were more didactic, appearance-based, myth-busting, used celebrity endorsements, and targeted self-exams received the most engagement. Messages without images received a higher rate of likes, shares and comments compared with messages that included images.

Limitations of the study include the inability to determine if those following the pages studied are representative of populations at risk for skin cancer and the potential of missed messages based on the keywords used for inclusion criteria. Authors state that collaborations between health institutes and researchers could identify characteristics of messages that are both effective for behavior change and produce high engagement rates in order to have the greatest impact on skin cancer prevention.


  1. Social media fact sheet. Pew Research Center Web site. Available at: http://www.pewinternet.org/fact-sheet/social-media/. Published February 5, 2018. Accessed April 24, 2018.
  2. Key statistics for melanoma skin cancer. American Cancer Society Web site. Available at: https://www.cancer.org/cancer/melanoma-skin-cancer/about/key-statistics.html. Updated January 4, 2018. Accessed April 24, 2018.
Real Health Photos – National Safety Month

Real Health Photos – National Safety Month

For 100 years, the National Safety Council has been the leading safety advocate preventing unintentional injuries and death in the United States. The Council’s National Safety Month, Observed annually in June, focuses on reducing leading causes of injury and death on the job, on the road, in the home, and in all communities. Specific areas they address include workplace violence prevention, safe driving, poisoning prevention, ergonomics, and fall prevention.

More than 33,000 people, for example, died in falls in 2015, according to the National Safety Council. “Falling is the third leading cause of unintentional injury-related deaths over all age groups, but it’s the #1 cause of death for those 65 and older” (Injury Facts 2017, National Safety Council). Strategies for preventing falls include securing carpets to the floor, wiping up spills immediately, installing grab bars in tubs, in showers, and near toilets, and if necessary, provide personal walking devices, such as canes or walkers, to aid in stability.

Klein Buendel’s Real Health Photos stock photography enterprise includes numerous images of older adults using personal walking devices. These unique photographs can be used in educational materials to show older adult populations how easy and typical it is for people to use devices for safe walking.

Real Health Photos images show a diversity of gender, race, ethnicity, age, income level, and health condition. Use Real Health Photos for improving the impact of health campaigns for people from all walks of life, including older adults.

Senior lady with caneSenior man with caneSenior lady with cane 2Senior man with cane 2
For more images, visit Real Health Photos.

Real Health Photos Logo

Real Health Photos is a stock photography service owned and operated by KB. It was created and evaluated with a research grant (R44MD003338, Mary Buller, Principal Investigator) from the National Institute of Minority Health and Health Disparities at the National Institutes of Health. Real Health Photos is designed to capture the diversity of health through photography and promote the inclusion of all populations in health promotion materials and media.

Real Health Photos® is a KB registered trademark.

BeVaccinated Web App Usability Testing

BeVaccinated Web App Usability Testing

Dr. W. Gill Woodall from Klein Buendel and the University of New Mexico presented findings from the BeVaccinated project at the 68th Annual Conference of the International Communication Association in Prague, Czech Republic, May 24-28, 2018. The project tested the usability of a prototype web app for improving adolescent vaccination uptake.

While vaccination rates for young children in the U.S. currently meet recommended standards, the CDC reports adolescent vaccines uptake (Gardasil 9 for HPV, MCV4 for meningococcal infection, Tdap for Tetanus, Diptheria and Pertussis protection, and Varicella vaccine for Chickenpox protection) to be less than optimal. In the case of the Human Papillomavirus (HPV) vaccine, rates are seriously below desired uptake levels. Despite established safety and effectiveness information about these vaccinations, and a wide variety of medical organizations recommending them, parents continue to have concerns about them, particularly the HPV vaccine.

For health communication researchers focused on Diffusion of Innovations, this is a classic difficulty of lack of effective messaging to prompt the uptake of an innovation by closing a knowledge gap among parents, in this case, on effective adolescent vaccines. The CDC and the Presidents Cancer Panel call for the development of effective and accessible messaging to improve vaccine decision-making as well as uptake. Because parents drive the decision to, and action for, vaccine uptake, messaging should be focused on them, but not exclusively, as there are benefits from parents and adolescents communicating about vaccines specifically and health issues generally. Approaching the vaccines as a recommended adolescent vaccine panel instead of each vaccine singularly may provide adoption benefit, as a vaccine panel approach builds the normative expectation for getting all adolescent vaccines as a group.

To address this vaccine uptake deficit, a web-browser application prototype, BeVaccinated, was developed to test reactions to and feasibility of delivering adolescent vaccine information via a smartphone. The majority of adults of parenting age own smartphones and use them to access online information, especially minority adults, and use mobile apps for information acquisition and decision support, making them a potentially efficacious channel for delivering vaccine information and tools. The prototype app was developed via formative research with focus group participants and guided by an Expert Advisory Board (EAB) comprised of vaccination experts and clinicians. Usability testing 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. Parents and teens reported that the prototype app was easy to use. Users reported that they could learn to use it quickly and that they were confident using it. With feasibility established, the full version of the app will be designed to improve dissemination of vaccine information, improve 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. W. Gill Woodall, Principal Investigator). Collaborators included Julia Berteletti from KB; Dr. Randall Starling, Dr. Alberta Kong, and Dr. Lance Chilton from the University of New Mexico; Dr. Greg Zimet from Indiana University; and Dr. Nathan Stupiansky from the University of Arizona.

Effects of the Sun Safe Workplaces Program

Effects of the Sun Safe Workplaces Program

Occupational skin cancer prevention is an international priority. People who work outdoors are routinely exposed to high levels of ultraviolet radiation (UV), the primary risk factor for skin cancer. Dr. Barbara Walkosz from Klein Buendel presented findings from the Sun Safe Workplaces project and a follow-up assessment at the 68th Annual Conference of the International Communication Association in Prague, Czech Republic, May 24-28, 2018.

Sun Safe Workplaces (SSW) was a communication theory-based workplace sun safety program for public organizations that employ people who work outdoors. Examples of outdoor work include road and bridge work, parks and recreation facilitation, sanitation and water works, and public safety. The original SSW project promoted the adoption of workplace sun safety policies in the public organizations and provided training in personal sun protection for outdoor workers in a randomized controlled trial. The follow-up study assessed the impact of SSW on employee sun safety behavior.

Sixty-one of the 98 public employers from the original study participated. Managers and line supervisors reported program implementation. A total of 1,784 outdoor workers (913 from the intervention group and 871 from the control group) completed surveys on personal sun protection practices.

In summary, employees’ sun protection improved statistically significantly in the intervention group receiving the SSW program. SSW’s effect on employee sun protection was mediated by the number of workplace actions to implement elements of sun safety policy including sun protection messages and equipment in the workplace and employee reports of training in sun safety.

This research was funded by a grant from the National Cancer Institute (RO1CA187191; Dr. David Buller, Principal Investigator). In addition to Dr. Walkosz and Dr. Buller from Klein Buendel (KB), collaborators/co-authors included Mary Buller from KB; Dr. Allan Wallis from the University of Colorado Denver; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; Dr. Michael Scott from Mikonics, Inc.; Dr. Peter Andersen from San Diego State University; and Dr. Gary Cutter from the University of Alabama, Birmingham.

KB Receives Train to Tend® Trademark

KB Receives Train to Tend® Trademark

Klein Buendel has received trademark registration through the U.S. Patent and Trademark Office (USPTO) for the Train To Tend® product name and logo. This is the sixth registered trademark for a KB-owned or co-owned product. KB also has registered trademarks for the following technology-based health education programs:

  • Real Health Photos® – a stock photography website of diverse, under-represented people
  • Way To Serve® (with the University of New Mexico) – an online responsible alcohol server training program
  • Sunny Days, Healthy Ways® – a sun safety curriculum for grade K-5
  • Momzing® – a collection of videos for moms to exercise with their babies and toddlers
  • sunZapp® – a mobile phone app for personal sun protection advice

According to the USPTO, “A trademark is a brand name. A trademark or service mark includes any word, name, symbol, device, or any combination, used or intended to be used to identify and distinguish the goods/services of one seller or provider from those of others, and to indicate the source of the goods/services.”

The Train To Tend® logo was designed by Steve Fullmer, KB Creative Director, for a research project funded by the National Institute on Drug Abuse (R44DA038933). The Principal Investigator for the study is Dr. David Buller, KB Director of Research. His KB lead Co-Investigator is Dr. W. Gill Woodall, KB Senior Scientist. This project’s specific aims are to produce a comprehensive, compliant online responsible marijuana vendor training program —TrainToTend®. The training for the retail and recreational marijuana industry is intended to increase knowledge of state regulations for the sale of cannabis products in states that have legalized recreational cannabis, such as Colorado, Oregon, and Washington. The training also covers responsible sales practices, such as ID checking, safe storage, robbery prevention, the health effects of marijuana, and other industry-related content.

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.