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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.

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. 

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.

Workplace Sun Safety Training Goes All-Virtual

Workplace Sun Safety Training Goes All-Virtual

People who work outdoors are exposed to high levels of solar ultraviolet radiation (UV) over a lifetime that can substantially increase their risk for developing skin cancer. Workplaces can be an effective channel for UV safety policy and training for employees in order to reduce their UV over-exposure and risk for skin cancer.

Klein Buendel researchers and their collaborators have been developing, evaluating, and refining comprehensive approaches to occupational sun protection for two decades. Now, the experienced research team is launching a new project funded by the National Cancer Institute to develop and evaluate a mechanism for distributing an established sun protection program virtually to diverse workplaces in the United States. The virtual environment will be comprised of a database, content management (interactive toolbox), and media platform (trackable training) to tailor the sun safety program to management’s readiness to innovate on sun safety based on Diffusion of Innovations Theory. In addition, the virtual platform will better integrate sun safety training by improving appropriateness for Hispanic and African American workers and conforming with the latest learning management systems technologies.

The Fast-Track SBIR project (CA257778) will complete a 9-month Phase I feasibility study and a 2-year Phase II effectiveness trial through employers across the country. The primary hypothesis of the study is that compared to employers in a minimal information control group, employers assigned to receive SSW Works will have employees that practice more sun protection at posttest. The research will be led by Mary Klein Buller, Principal Investigator. Co-Investigators include Dr. Barbara Walkosz, Julia Berteletti, and Dr. David Buller from Klein Buendel. The virtual platform will be engineered by Klein Buendel’s Creative Team.

The outdoor workforce in the United States is large and, in many places, at very high risk for skin cancer. Improving sun safety will help reduce health care costs and save lives. Thus, the research will have high impact and potential for commercial adoption, two objectives of SBIR projects.

Adopting Policy to Eliminate Indoor Tanning

Adopting Policy to Eliminate Indoor Tanning

Dr. David Buller from Klein Buendel joined two other behavioral scientists to publish a Viewpoint in JAMA Dermatology in April calling on dermatologists and others to support legislative efforts and other policies in their local areas to help dramatically curtail indoor tanning in the United States. The other two authors were Dr. Carolyn Heckman from the Rutgers Cancer Institute of New Jersey and Dr. Jerod Stapleton from the University of Kentucky.

The Viewpoint describes policy and regulation as “among the most effective strategies for influencing health behaviors and public health.” Indoor tanning restrictions in multiple states are helping to reduce skin cancer incidence and death.  Achieving continued and additional restrictions will require concerted research, advocacy, and policy efforts to overcome remaining barriers to new laws and to close lingering gaps in existing laws.

In their editorial, the authors put out a Call to Action to dermatologists to increase their awareness of local indoor tanning laws, or lack thereof, and to educate their patients, legislators, school boards, local business groups, and others about the dangers of indoor tanning and the need for more restricted use, especially by minors.

The Viewpoint was published online in JAMA Dermatology on April 28, 2021.

Written Policy Predicts Worksite Sun Safety Training and Actions in State Departments of Transportation

Written Policy Predicts Worksite Sun Safety Training and Actions in State Departments of Transportation

Dr. David Buller, Klein Buendel Director of Research, presented a poster on workplace sun safety policies at the virtual 13th Annual Conference on the Science of Dissemination and Implementation in Health December 15-17, 2020.  

The U.S. Surgeon General and Community Guide recommend implementation of interventions to protect outdoor workers from solar ultraviolet radiation (UV) exposure to prevent skin cancer. For the research presented in this poster, written policies at state Departments of Transportation (DOTs) were examined and analyses tested the hypothesis that presence and strength of sun safety policy would be associated with greater implementation of workplace sun safety actions. 

Written policies from 21 U.S. state DOTs were coded for 15 sun safety components including engineering controls (physical work environment), administrative controls (workplace procedures), and personal protection practices (workers’ sun safety). Managers supervising outdoor workers in 138 regional DOT districts reported on workplace sun safety training and actions (monitoring UV Index to adjust work schedules, employees wearing UV-protective clothing, hats, eyewear, and sunscreen, sun safety messages to employees, employer provides sun protection resources and temporary/permanent shade, employer requests contractor staff comply with policy, employer encourages employees to regularly check skin, and employer conducts a risk assessment). 

Twenty state DOTs had a policy with at least one sun protection component (e.g., sunscreen, clothing, hat, shade provision, adjusting schedules), but almost none included training of employees, managers or supervisors. Many policies were also not explicitly intended for sun safety, except for sunscreen. Though not written, some reported unwritten standard operating, administrative, or training procedures on sun protection. Sun safety training and actions were predicted by a written sun safety policy and unwritten procedure, managers’ behaviors, job responsibilities, and characteristics. 

Policies are essential for implementation and maintenance of employee sun safety. While many state DOTs have policies, they could be improved by explicitly referencing sun safety. Also, training should be added to policy to create collective commitment among managers to support policy implementation and improve employees’ sun safety skills on the job. 

This research is funded by a grant from the National Cancer Institute (CA134705; Dr. David Buller, Principal Investigator). Additional poster coauthors included Dr. Barbara Walkosz, Mary Buller, Rachel Eye, Andrew Grayson, Alishia Kinsey, Xia Liu, and Savanna Olivas from Klein Buendel. 

Listen to the poster presentation.

Tattoo Aftercare Instructions and Sun Protection

Tattoo Aftercare Instructions and Sun Protection

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

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

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

This research team was funded by a grant and supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Authors include Dr. Cristian Gonzalez from the Department of Dermatology at University of Colorado School of Medicine, Dr. Barbara Walkosz from Klein Buendel, and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the U.S. Department of Veterans Affairs Rocky Mountain Regional VA Medical Center Dermatology Service.  

Dr. Robert Dellavalle Honored by Melanoma Research Foundation

Dr. Robert Dellavalle Honored by Melanoma Research Foundation

Robert P. Dellavalle, MD, PhD, MSPH, is being honored with the first Excellence in Prevention Award from the Melanoma Research Foundation at the 2020 Denver Virtual Gala on August 6, 2020. Dr. Dellavalle, a longtime Klein Buendel research collaborator, is a Professor of Dermatology and Public Health at the University of Colorado School of Medicine, and chief of the Dermatology Service at the Rocky Mountain Regional Veterans Administration Hospital in Aurora, Colorado.

Dr. Dellavalle is a lifelong melanoma awareness advocate and leads a prominent research laboratory focused on skin disease prevention and evidence-based dermatology. His laboratory has investigated skin cancer chemoprevention both in vitro and in clinical practice. Their key discoveries include ranking the most disabling skin diseases in the world and in the United States. The laboratory was also the first to summarize global indoor UV tanning age restriction laws, measure compliance with tanning age restrictions, and call for a tax on UV tanning. The research showed that UV tanning salons target minors using advertisements in high school newspapers and that tanning salon operators do not adequately inform customers of the health risks. These discoveries were featured on national television network nightly news and in the U.S. Surgeon General’s recent Call to Action to Prevent Skin Cancer.

Currently, Dr. Dellavalle is a Multiple Principal Investigator on Sun Safety Ink!: A Skin Cancer Prevention Program for the Tattoo Community (CA206569) and he is a consultant on Using Technology to Scale-up an Occupational Sun Protection Policy Program (Sun Safe Workplaces Technology) (CA134705). Both are Klein Buendel research projects funded by the National Cancer Institute. Sun Safety Ink! is a skin cancer prevention program for tattoo artists and their clients and Sun Safe Workplaces Technology is a scale-up of an occupational sun protection program for State Department of Transportation employees, who work outdoors. Dr. Dellavalle works closely with Dr. Barbara Walkosz and Dr. David Buller from Klein Buendel on these projects.

Dr. Dellavalle has multiple publications in the highest impact scientific journals including Science, Journal of the American Medical Association, and Nature. He is an affiliate of the American Academy of Dermatology, the Society of Investigative Dermatology, and the Colorado Dermatologic Society. He is also the coordinating editor of the Cochrane Skin Review, that aims to accept for review any aspect of skin disease management which it feels will be of value to professionals or to lay people with an interest in skin disease. Since 2010 he has co-chaired the Colorado Skin Cancer Task Force promoting sun safety and increasing awareness for skin cancer prevention across Colorado at public community events, employee conferences, and school meetings.

Congratulations, Dr. Dellavalle on a well deserved award!

Investigation of Indoor Tanning Policy Enactment

Investigation of Indoor Tanning Policy Enactment

Klein Buendel is collaborating with Dr. Carolyn Heckman and her team from Rutgers University on a new research project to study the process of translating indoor tanning policy efforts into stringent legislation and compliance, and the effects of the legislation on reduced indoor tanning by minors in the United States.

Indoor tanning is a well-established cause of skin cancer (1-8,10). Most tanners begin indoor tanning as teens or young adults (22). In order to reduce indoor tanning and protect this at-risk population, indoor tanning is currently being regulated in two ways. First, some states restrict access by minors or require parental consent or accompaniment (11). Second, the Food and Drug Administration (FDA) attempts to minimize harm from indoor tanning devices with precautions like protective eyewear and session duration limits (12).  Recent evidence suggests that more stringent indoor tanning laws such as age bans (vs. parent consent laws or no law) are associated with less youth indoor tanning (15,16). Unfortunately, enforcement and compliance with laws are variable and inadequate (9,17-21). Although underutilized (13), legislation such as age restrictions and taxation has been quite successful in decreasing engagement in other risky behaviors such as smoking (14).

The goals of this five-year research project are to (1) clarify the indoor tanning legislation adoption process, (2) employ a pseudo-patron assessment, national survey, and archival data to investigate legislation implementation, 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.

Health-related policy adoption and promotion is an effective, yet underutilized, strategy for health promotion. To protect the public from melanoma and non-melanoma skin cancer, government bodies have begun to enact legislation to restrict minor access to indoor tanning and minimize harm from indoor tanning devices. In order to contribute to the currently limited evidence base for future policy decision making and sustainability and to accelerate reductions in indoor tanning and sunburn, this project will address policy characteristics associated with regulation compliance, cost-benefits of these policies, and barriers and facilitators of policy adoption.

This research project is funded by the National Cancer Institute (CA244370; Dr. Carolyn Heckman, Rutgers University, and Dr. David Buller, Klein Buendel, Multiple Principal Investigators). Collaborators include Dr. Rich Meenan from the Kaiser Permanente Center for Health Research; Dr. Jared Stapleton from the University of Kentucky; Dr. Shawna Hudson, Dr. Cristine Delnevo, and Dr. Kevin Schroth from Rutgers University; and Julia Berteletti from Klein Buendel.

References

  1. Lergenmuller S, Ghiasvand R, Robsahm TE, et al. Association of Lifetime Indoor Tanning and Subsequent Risk of Cutaneous Squamous Cell Carcinoma. JAMA dermatology. 2019:1-9.
  2. O’Sullivan DE, Brenner DR, Villeneuve PJ, et al. Estimates of the current and future burden of melanoma attributable to ultraviolet radiation in Canada. Preventive medicine. 2019;122:81-90.
  3. Gandini S, Dore JF, Autier P, Greinert R, Boniol M. Epidemiological evidence of carcinogenicity of sunbed use and of efficacy of preventive measures. Journal of the European Academy of Dermatology and Venereology : JEADV. 2019;33 Suppl 2:57-62.
  4. Suppa M, Gandini S. Sunbeds and melanoma risk: time to close the debate. Current opinion in oncology. 2019;31(2):65-71.
  5. O’Sullivan DE, Brenner DR, Demers PA, Villeneuve PJ, Friedenreich CM, King WD. Indoor tanning and skin cancer in Canada: A meta-analysis and attributable burden estimation. Cancer epidemiology. 2019;59:1-7.
  6. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ : British Medical Journal. 2012;345:e4757.
  7. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: Systematic review and meta-analysis. Journal of the American Academy of Dermatology. 2014;70(5):847-857.e818.
  8. El Ghissassi F, Baan R, Straif K, et al. A review of human carcinogens–part D: radiation. The Lancet Oncology. 2009;10(8):751-752.
  9. Reimann J, McWhirter JE, Papadopoulos A, Dewey C. A systematic review of compliance with indoor tanning legislation. BMC public health. 2018;18(1):1096.
  10. Burgard B, Schoepe J, Holzschuh I, et al. Solarium use and risk for malignant melanoma: meta-analysis and evidence-based medicine systematic review. Anticancer research. 2018;38(2):1187-1199.
  11. National Council of State Legislatures. Indoor Tanning Restrictions for Minors: A State by State Comparison. http://www.ncsl.org/research/health/indoor-tanning-restrictions.aspx. Published 2018. Updated 11/2/2018. Accessed.
  12. Food and Drug Administration. Sunlamp products and ultraviolet lamps intended for use in sunlamp products. In. Vol 8. Silver Spring, MD: Food and Drug Administration; 2018.
  13. Abrams DB, Graham AL, Levy DT, Mabry PL, Orleans CT. Boosting population quits through evidence-based cessation treatment and policy. American journal of preventive medicine. 2010;38(3 Suppl):S351-363. PMCID: PMC4515751.
  14. Brownson RC, Haire-Joshu D, Luke DA. SHAPING THE CONTEXT OF HEALTH: A Review of Environmental and Policy Approaches in the Prevention of Chronic Diseases. Annual Review of Public Health. 2006;27(1):341-370.
  15. Guy GP, Berkowitz Z, Jones SE, Holman DM, Garnett E, Watson M. Trends in indoor tanning among US high school students, 2009-2013. JAMA dermatology. 2015;151(4):448-450.
  16. Qin J, Holman DM, Jones SE, Berkowitz Z, Guy Jr GP. State Indoor Tanning Laws and Prevalence of Indoor Tanning Among US High School Students, 2009–2015. American journal of public health. 2018;108(7):951-956.
  17. Driscoll DW, Darcy J. Indoor Tanning Legislation: Shaping Policy and Nursing Practice. Pediatric nursing. 2015;41(2).
  18. Gosis B, Sampson BP, Seidenberg AB, Balk SJ, Gottlieb M, Geller AC. Comprehensive evaluation of indoor tanning regulations: a 50-state analysis, 2012. Journal of Investigative Dermatology. 2014;134(3):620-627.
  19. Mayer JA, Hoerster KD, Pichon LC, Rubio DA, Woodruff SI, Forster JL. Peer Reviewed: Enforcement of State Indoor Tanning Laws in the United States. Preventing chronic disease. 2008;5(4).
  20. Williams MS, Buhalog B, Blumenthal L, Stratman EJ. Tanning salon compliance rates in states with legislation to protect youth access to UV tanning. JAMA dermatology. 2018;154(1):67-72.
  21. Woodruff SI, Pichon LC, Hoerster KD, Forster JL, Gilmer T, Mayer JA. Measuring the stringency of states’ indoor tanning regulations: instrument development and outcomes. Journal of the American Academy of Dermatology. 2007;56(5):774-780.
  22. Tripp MK, Watson M, Balk SJ, Swetter SM, Gershenwald JE. State of the science on prevention and screening to reduce melanoma incidence and mortality: the time is now. CA: a cancer journal for clinicians. 2016;66(6):460-480.