Custody & Caring Conference

Custody & Caring Conference

A research team from Penn State University and Klein Buendel gave three presentations on their recent work related to the care of persons aging and dying in prison at the 18th Biennial International Conference on the Nurse’s Role in the Criminal Justice System. The Custody & Caring Conference was held in Saskatoon, SK, Canada on September 20-23, 2023.

Podium Presentation and Poster 1

“Small-Scale Usability Testing: E-learning Modules for Peer Caregivers”

Growing numbers of people globally will grow old and die while incarcerated. Research evidence supports using peer caregivers to assist staff with geriatric and end-of-life care. Currently, peer caregiver training varies widely in content and duration. Evidenced-based, accessible, and contextually relevant materials are needed to effectively prepare the caregivers. This study’s purpose was to conduct research and development of Just Care, a six-module e-learning program for peer caregivers and a single module to guide corrections staff in implementing the program. University IRB, U.S. Department of Health & Human Services, and Department of Corrections permissions were obtained, and participants signed informed consent. Deputy Wardens assisted in identifying people meeting our inclusion criteria. Nineteen people living in prison and 11 staff took part in the usability testing of the progam. Researchers directed participants to share their thoughts aloud. Field notes were taken. Participants completed six open-ended questions and the System Usability Scale (SUS).

Findings focused on functionality, design, and content of Just Care. All users easily navigated through the program with minimal guidance. Many noted Just Care’s utility for future peer caregivers. Challenges faced were clustered by level of severity from 1-3 (1=most; 3=least severe). There were no severity-level 1 issues in either round. In Round 1, Just Care received a SUS score of 87.5 by incarcerated users and 74.5 by staff. A SUS score of 68 is an above average score. Following rapid refinement, Round 2 incarcerated participants scored Just Care at 85.28 while staff scored it at 83.75. Some incarcerated users had difficulty navigating the post-test assessments in Round 2. A few staff users noted liking the additional resources available via links to PDFs. One staff user voiced concern about the safety of having incarcerated people help with care. Overall, participants found Just Care easy to navigate with interactive content that is very useful, engaging, and relevant to providing geriatric and end-of-life care in prisons. Staff also noted that Just Care raised awareness about the growing need for programming on geriatric care in prisons and that a peer caregiver program like Just Care is a viable solution that is implementable by prison staff.  

Poster 2

“Determining Priority Dementia Care Training Needs for Correctional Staff and Peer Caregivers”

People aged 50 and older in prisons are at particular risk for developing Alzheimer’s Disease and Related Dementias (ADRD) due to several social determinants of health. The number of patients in prison with ADRD is not known. This situation can likely be attributed to many corrections health, social, and security staff lacking the requisite skills for identifying ADRD. Dementia care inequities between prisons and community settings need to be addressed. A standardized, feasible, and acceptable ADRD education program developed for those caring for and/or managing people who are incarcerated and living with ADRD is a pressing need.

The key purpose of the research was to identify three priority learning needs of multidisciplinary prison staff to provide enhanced management and care for people living with ADRD in prisons which also represented the critical learning needs of peer caregivers so that they may assist staff with ADRD care. The study also sought to identify a logo to brand the new Just Care for Dementia training. The third outcome was to translate best practices from community-based ADRD care into accessible and relevant content for training staff and peer caregivers that is evidence-based and can be programmed into highly interactive prototype e-learning modules that fit within the restrictive context of corrections. Focus group methodology facilitated potential future users input to aid us in ensuring the content, design, and technology plans match the needs and constraints of prison. Approvals were secured from the: Institutional Review Board; federal government; and Department of Corrections. Participants provided signed informed consent. The settings were one men’s and one women’s state prison in the United States. Twelve interdisciplinary staff and 11 peer caregivers participated.

Thematic analyses revealed three priority content areas: fostering a safe and calm environment; addressing behavioral and psychological symptoms of dementia; and enhancing awareness of need. Insights on nine showcased logos revealed two clear preferences. Consultation with the study’s advisory board informed final logo selection for branding the Just Care for Dementia e-learning product. In conclusion, participants confirmed the need for a such a training program and indicated this is a viable approach to addressing a pressing training and related care need in prisons.

This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging [AG057239; Dr. Susan Loeb (Penn State) and Dr. Barbara Walkosz (Klein Buendel), Multiple Principal Investigators]. Collaborators on the presentation and posters also included Dr. Erin Kitt-Lewis, Mr. Sherif Olanrewaju, and Ms. Katherine Aiken from The Penn State University; and Mr. Brandon Herbeck, Ms. Amanda Brice, and Mr. Steve Fullmer from Klein Buendel.  

Challenging Violence in the Media

Challenging Violence in the Media

Klein Buendel and the Center for Media Literacy in California are launching a new research project to update and translate Beyond Blame: Challenging Violence in the Media, an evidence-based media-literacy violence prevention curriculum for middle school students, formerly delivered in person, into an interactive technology-based platform. Beyond Blame, developed by the Center for Media Literacy,is a theory-based curriculum that underwent a rigorous long-term evaluation, in the Los Angeles Unified School District. Violence prevention programs, including school-based education programs, are recommended to address youth violence.

According to the Centers for Disease Control and Prevention (CDC), “youth violence is a serious public health problem and that an adverse childhood experience can have a long-term impact on health and well-being, disproportionately impacting communities of color.” Violence affects thousands of youths each day as well as their families, schools, and communities. CDC reports that youth can be involved in violence as a victim, offender, or witness. Homicide is the third leading cause of death for young people ages 10-24 and the leading cause of death for non-Hispanic Black or African American youth.1,2 However, youth violence is preventable and the development of evidence-based approaches that address the factors to decrease the risk of violence, buffer against that risk, and promote positive youth development and well-being3 are imperative.  

A number of factors exist that may increase or decrease the possibility of youth experiencing or enacting violence. Media violence has long been identified by public health as a risk factor and violent content in television, social media, and video games has been associated with aggression and youth violence. Yet, media literacy programs are often not included in violence prevention efforts. Media literacy is recognized as a life skill to strengthen and provide resiliency for an individual’s ability to resist negative and harmful messages that are powerfully packaged and promoted in the media.

Today, youth live in an unprecedented mediated environment. With technology allowing 24-hour media access, the amount of time youth spend with media has risen dramatically, especially among minority youth. This is evidenced by widespread media usage by middle school children: 98% watch television, 78% use tablets, 67% interact with smart phones, 73% use computers, and 68% use gaming devices. Children ages 8-12 in the U.S. average 4-6 hours a day watching or using screens. To help children navigate this mediated environment, media literacy education provides a framework to access, analyze, evaluate, create and participate using media in a variety of forms, including videos, social media (such as TikTok and You Tube), video games, film, and television.  

Upon completing Beyond Blame in person, students significantly increased their knowledge of the Five Core Concepts/Key Questions of media literacy, increased recognition of their exposure to media violence, and had stronger beliefs that media violence affects users. The original Beyond Blame aligns with the Common Core standards identified for Language Arts, and the technology-based curriculum will adhere to the same standards along with the International Society for Technology in Education Standards that ensure that using technology for learning can create high-impact, sustainable, scalable, and equitable learning experiences for all learners. 

This research is supported by a grant from the CDC (1 R43CE003635-01-00). The project team will be led by Multiple Principal Investigators, Dr. Barbara Walkosz, a Senior Scientist at Klein Buendel, and Ms. Tessa Jolls, President of the Center for Media Literacy and will be joined by a Co-Investigator, Dr. Christine Rizzo from Northeastern University in Massachusetts. The Klein Buendel Creative Team will design and program the Beyond Blame prototype. 


  1. David-Ferdon C, Clayton HB, Dahlberg LL, et al. Vital signs: Prevalence of multiple forms of violence and increased health risk behaviors and conditions among youths – United States, 2019. MMWR Morb Mortal Wkly Rep. 2021;70(5):167-173. doi: 10.15585/mmwr.mm7005a4.PMC7861486  
  2. Sheats KJ, Irving SM, Mercy JA, et al. Violence-related disparities experienced by black youth and young adults: opportunities for prevention. Am J Prev Med. 2018;55(4):462-469. doi: 10.1016/j.amepre.2018.05.017.PMC6691967 
  3. Youth topics: violence prevention. Interagency Working Group on Youth Programs. Available at: Accessed March 28, 2022. 
Introducing Way To Serve Español!

Introducing Way To Serve Español!

WayToServe®, an evidence-based online responsible alcohol server training program, has been launched in Spanish in California – as Way To Serve Español – to meet the needs of Spanish-speakers in the food and beverage industry.

Responsible Beverage Service (RBS) training has shown promise to reduce alcohol-related injury and mortality. WayToServe was created by scientists and developers from the University of New Mexico, the Pacific Institute for Research and Evaluation, and Klein Buendel. The engaging, media-rich program was initially evaluated in a randomized controlled trial that resulted in high trainee satisfaction and increased refusal of sales to intoxicated patrons. WayToServe was licensed to Wedge Communications LLC and launched into the online marketplace in 2012. To date, WayToServe has been expanded and approved for sale and certification of trainers in New Mexico, California, Texas, and Washington. Wedge Communications will distribute Way To Serve Español, as well.

The original WayToServe project was sponsored by two grants from National Institute on Alcohol Abuse and Alcoholism to the University of New Mexico (AA014982 and AA016606; Dr. W. Gill Woodall, Principal Investigator). The subsequent WayToServe Español project was sponsored by a grant from the National Institute of Minority Health and Health Disparities (MD010405; Dr. W. Gill Woodall, Klein Buendel Senior Scientist, Principal Investigator). Collaborators included Dr. Robert Saltz from the Pacific Institute for Research and Evaluation; Dr. Frank Perez and Dr. Areli Chacon Silva from the University of Texas at El Paso; Dr. Victoria Sanchez and Dr. Randall Starling from the University of New Mexico; Dr. David Buller, Ms. Jeanny Camacho Reither, Ms. Lila Martinez, and Ms. Marita Brooks from Klein Buendel. 

KB and HPC International Launch Pinpoint

KB and HPC International Launch Pinpoint

Klein Buendel has partnered with HPC International, a leading purchased services provider for healthcare, corporations and academic institutions, to create Pinpoint™, the first-of-its-kind sickle cell pain management app, which provides a safe, interactive, and convenient way for patients to learn about, track, assess, and communicate with their doctors about their sickle cell pain.

The Pinpoint sickle cell pain management app provides a safe, interactive, and convenient way for patients to learn about, track, assess, and communicate with their doctors about  sickle cell pain.

Developed with teens in mind, people of all ages benefit from the Pinpoint app to identify different types of pain associated with sickle cell disease. Using gaming technology, Pinpoint offers an innovative pain assessment tool and a pain diary to log physical and emotional pain symptoms. With the touch of a finger, patients are able to describe and assess the intensity, duration, quality, nature, and location of the pain and report it to their caregivers and physician in real-time. Pinpoint is a web app and works on any smartphone or smart mobile device. Patients can play games, watch videos, learn preventive health tips, and visit the Patient Stories section with real stories and inspirational messages told by other sickle cell patients. 

Sickle cell disease is an inherited disorder of the red blood cells that disproportionately affects people of color. Chronic pain is the most common complication and profoundly disrupts people’s quality of life. Clinicians are often unsuccessful at addressing chronic pain in sickle cell disease, underscoring the need for the Pinpoint app. 

“The pain caused by sickle cell disease is incredibly difficult to manage and ‘pinpoint,’ especially for young patients,” said Hilton Hudson, MD, FACS, CEO of HPC International. “When meeting with top researchers at Children’s Hospital in Washington D.C., we all agreed that clinicians needed a better way to treat the different types of pain sickle cell patients may experience, which led HPC to develop a tool to do just that.” 

“Teaming up with HPC International and supported by grants from the NIH, Klein Buendel was privileged to create a supportive pain management tool for patients with sickle cell disease,” said Mary Buller, MA, President of Klein Buendel. “HPC and Klein Buendel combined content experts and web developers into a winning combination for patients and doctors.” 

The educational content in the Pinpoint app comes from the renowned and best-selling Hope & Destiny book series, written by three clinical expert leaders in hematology: James Eckman, MD, Lewis L Hsu, MD, PhD and Allan Platt, PA-C, MMSc. Hope & Destiny is Hilton Publishing’s premier educational book series on sickle cell disease and is tailored for different reader age groups, including adults and parents as well as adolescent patients. 

The Pinpoint app development project was facilitated through two Small Business Innovative Research (SBIR) grants, awarded in 2016 and 2018 by the National Institutes of Health (NIH). HPC collaborated with Klein Buendel, medical experts, teens, and parents of children with sickle cell disease to study how an interactive app with a customized pain assessment tool could provide an improved way for adolescents with sickle cell disease to learn about and better manage their disorder. The study’s Expert Advisory Board was formed by clinicians from institutions and nonprofit organizations including HOPE for SCD, UIC, Emory Healthcare, Children’s National, Marquette University College of Nursing, and the International Association of Sickle Cell Nurses and Professional Associates.

Pinpoint has been clinically evaluated to help aid in the management of pain caused by sickle cell disease. Market research, focus groups, surveys, interviews, and two comprehensive research studies were conducted virtually and in-person with teens, parents and clinical specialists representing communities across the country from 2016 through 2022.  Research reported in this press release was supported by the National Institute on Minority Health and Health Disparities under grant numbers R43MD010746 and R44MD010746 awarded to Klein Buendel (Dr. Valerie Myers, initial Principal Investigator; Ms. Julia Berteletti, final Principal Investigator). Pinpoint was designed and programmed by Mr. Adam Ashby of the Klein Buendel Creative Team.

Already, Pinpoint has been featured in:

Sickle Cell Disease News, a healthcare industry website, which provides the sickle cell disease community with the most recent news and information on sickle cell disease.

MedCity News, a leading digital healthcare outlet. in their Health & Medicine section on August 23rd.

Healthcare IT Today, a leading digital health tech outlet, in a roundup of healthcare industry news (under the ‘Partnerships’ section) on August 17th.

Pinpoint is available to individuals and medical providers. An individual annual subscription fee is $9.99. To learn more about the Pinpoint app, check out the video tutorial or visit HPC International.

Results of the ¡Caminemos Juntas! Project

Results of the ¡Caminemos Juntas! Project

Klein Buendel researchers and collaborators from Stanford University have completed an SBIR Phase I and II project to develop and evaluate the effectiveness of the first smartphone app to use geo-location technology dedicated to walking with a social emphasis for exercise and quality of life for Latinas.

Health disparities are high among Latinas. They are more likely to be overweight, diagnosed with diabetes, and physically inactive compared to their non-Hispanic White counterparts. Despite numerous interventions designed to increase physical activity, few are specifically tailored to Latinas. Thus, this project developed ¡Caminemos Juntas!, a smartphone app that uses location-based services to connect Latinas with one another in order to improve walking habits by increasing social support and decreasing perceived barriers.

Available data suggest that community-focused interventions produce improvements in physical activity and are well-received by Latinas, especially when social and physical environments, such as social support and safe walking areas, are considered. Research suggests that Latinas respond favorably to technological-based health interventions. Thus, health promotion interventions that can address Latinas’ preferences regarding their physical and social environments while utilizing a preferred technology source have the potential to be very effective.

Phase I Project

In the Phase I project, formative research was conducted to guide development of a prototype smartphone app for the target population. Specifically, the research and development team:

(1) gathered feedback from an Expert Advisory Board to help plan and assess the feasibility of creating the app;

(2) built connections and gathered input from Latina community leaders to assist in the conceptual development of the app through a Community Advisory Board;

(3) conducted an online survey of a national sample of Latinas on their smartphone usage for health promotion, and interest in social networking and location-based technology features;

(4) conducted iterative focus groups with Latinas to guide development of app content, design, and aesthetics to fully develop a functioning prototype;

(5) conducted field usability testing with Latinas to test the app’s accuracy to establish users’ location and connect users through the ¡Caminemos Juntas! system and users’ use and satisfaction with the app; and

(6) developed a specifications document to outline the Phase II development and programming plan.

The results of the Phase I study revealed that 22.5% of Latina participants never or rarely exercised, 73.5% accessed social networking sites daily with an average of 8 times a day, and 43.9% used location-based technology every day. Ease of use (82%), informationally accurate (79.2%), and reliability (84.7%) were app features rated as highly important. Over 63% reported high likelihood of using a social networking app to connect to others with the intentions of being physically active, and 67.4% reported that this type of app would be very helpful. Focus groups showed that the app was appealing, also.

Phase II Project

In the Phase II project, the ¡Caminemos Juntas! app was fully developed and evaluated in a randomized comparative-effectiveness trial with Latinas in San Jose, CA and Denver, CO. The location-based features of the app allowed Latinas to determine a safe place to meet for a walk, connect with other users nearby, and be notified if there was an available walk in the user’s vicinity. Specifically, the research and development team:

(1) developed a full-scale, fully programmed ¡Caminemos Juntas! app;

(2) determined whether the ¡Caminemos Juntas! app can be translated and adapted to a new community environment;

(3) tested the performance, usage, and usability of the full-scale, fully-programmed app; and

(4) evaluated whether ¡Caminemos Juntas! increases physical activity, social support for exercise, and quality of life in Latinas as compared to a control app.

The ¡Caminemos Juntas! app (intervention group; n=38) was compared to use of the World Walking App (control group; n=40). Women ages 18 to 67 who identified as Hispanic or Latina were eligible to participate. Recruitment, retention, and implementation were hindered significantly by the onset of the COVID-19 pandemic. The intervention was set to launch in the spring of 2020. Recruitment was delayed and when it was determined that the pandemic would be a long-term hinderance, changes were made to the app to allow participants to complete virtual walks instead of in-person. Eighty-eight percent (88%) of participants (n=69) completed measures at 4 weeks and ninety-seven percent (97%) of participants (n=76) completed measures at 8 weeks.

The primary outcome measure was change in physical activity at 4 and 8 weeks using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. The CHAMPS is a 41-item questionnaire that measures self-reported minutes-per-week of physical activity calculated as total weekly caloric expenditure for all physical activity. It was developed for underactive populations and validated among older adults. The CHAMPS asks about activities undertaken for exercise, daily activities that are physical in nature, and physically active recreational activities during a typical week in the past 4 or 8 weeks. Each question has six answer options that range from “Less than 1 hour” to “9 or more hours.” At the 8-week follow-up, participants in ¡Caminemos Juntas!  reported 5.2 hours per week of moderate-intensity exercise related activities per week compared to 4.3 hours in the control group, though this result is not statistically significant.

Participants in the intervention group reported living in more walkable (35.3% of intervention participants rated their sidewalks very well maintained compared to 17.7% of control participants (p=0.04) and safer neighborhoods (63.6% of participants in the intervention rated the public recreation facilities in their neighborhood as very safe compared to 31.6% in the control (p=0.03). However, ¡Caminemos Juntas! users reported significantly lower street connectivity than the control group.

Overall, the ¡Caminemos Juntas! app was found to have the potential to impact Latinas’ health by providing them with real-time opportunities to connect socially with the goal of walking. Interventions that target improving health access and ameliorating chronic diseases among Latinas are of high public health importance.

This research was supported by a grant from the National Institute on Minority Health and Health Disparities (MD009652; Dr. Valerie Myers, former Klein Buendel Senior Scientist) at the National Institutes of Health. Dr. Myers’ primary collaborator was Dr. Abby King from Stanford University.

Physical Activity During the Early Days of the COVID-19 Pandemic

Physical Activity During the Early Days of the COVID-19 Pandemic

Dr. Kayla Nuss, KB Scientist, was part of a multi-institutional research team that published the results of a daily diary physical activity study in the Journal of Physical Activity and Health in July. The study, led by Ms. Kristen Moore from Colorado State University, reported on motivational profile as a predictor of physical activity among U.S. adults during the early months of the COVID-19 pandemic.

A total of 468 adults participated in a 28-day smartphone-based daily diary study assessing physical activity. Nearly 80% of the participants were female and the average age of participants was 34.8 years. Daily diaries were used to examine associations between day-level physical activity behavior, physical activity-specific motivational profile, and days since the COVID-19 national emergency declaration during the early months of the pandemic, specifically April-June 2020.

According to the publication in the Journal of Physical Activity and Health, a baseline survey assessed physical activity and motivation for physical activity using the Behavioral Regulation in Exercise Questionnaire. Multilevel linear regression models examined the main effects and interactions of motivational profile and time on daily physical activity minutes. Latent profile analysis identified four distinct motivational profiles for physical activity among this sample:


  1. High amotivation (21% of participants)
  2. Low controlled motivation (12% of participants)
  3. High external regulation (10% of participants)
  4. Moderate autonomous motivation (57% of participants)

After controlling for baseline physical activity, there were significant interactions between profile and time on daily physical activity. Profile 2 showed greater decreases in daily physical activity minutes over time than profile 1. Profiles 3 and 4 did not indicate significant decreases in physical activity compared with profile 1. Details on the methods and results of this research can be found in the publication.

The authors summarize that Individuals with lower controlled or moderate autonomous motivation demonstrated the largest decreases in physical activity over time, whereas individuals with higher amotivation or external regulation demonstrated smaller decreases over time. In conclusion, the authors suggest that external motivation may have provided short-term protection against declines in physical activity observed during early months of the COVID-19 pandemic.

This research was supported by the Assessment and Promotion of Physical Activity and Health Lab at Colorado State University and the Real-Time Eating Activity and Children’s Health Lab at University of Southern California. Authors in addition to Ms. Moore and Dr. Nuss include Dr. Shirlene Wang and Dr. Genevieve Dunton from the University of Southern California; Dr. Kaigang Li and Dr. Dan Graham from Colorado State University; Dr. Jimikaye Courtney from the University of North Carolina, and Dr. Bridgette Do from FitMinded, Inc.

Collaborator Spotlight:
Dr. Douglas Seals and Dr. Daniel Craighead

Collaborator Spotlight:
Dr. Douglas Seals and Dr. Daniel Craighead

Two accomplished integrative physiology scientists from the University of Colorado Boulder are launching a new research project in collaboration with Dr. Kayla Nuss and the Creative Team from Klein Buendel. The project will design and assess the feasibility of the using a smartphone app to help deliver a high-resistance inspiratory muscle strength training (IMST) program for improving blood pressure and reducing cardiovascular disease risk in midlife and older adults.

Douglas Seals, PhD, is a Distinguished Professor of Integrative Physiology (Boulder Campus) and Medicine (Anschutz Medical Campus) at the University of Colorado. He is also the Director of the Integrative Physiology of Aging Laboratory. He earned his doctoral degree in Applied Exercise Physiology from the University of Wisconsin in 1981. In his 35+ years of academics and research, Dr. Seals has become an expert on lifestyle and/or pharmacological interventions to improve cardiovascular function. His areas of research interest include cardiovascular aging, such as changes in systolic blood pressure, large artery stiffness, and vascular endothelial function; biological and lifestyle factors that influence cardiovascular aging; the integrative (molecular to systemic) mechanisms that mediate cardiovascular aging and its modulation by biological and lifestyle factors; and interventions to improve adverse physiological changes with aging, including cardiovascular dysfunction, reductions in motor performance, and impairments in cognitive function. His research has been continuously funded by research grants from the National Institutes of Health, particularly the National Institute on Aging, since 1986. Dr. Seals founded an NIH Clinical Translational Research Center at the University of Colorado Boulder in 1999 as a core facility for conducting biomedical research on human subjects. It was in this lab that Dr. Seals and Dr. Daniel Craighead (see below) established the efficacy of IMST for lowering blood pressure in a traditional clinical research setting. In 2004, Dr. Seals received a 10-year MERIT Award from the National Institute on Aging to support his research on cardiovascular aging. In 2008, he was named a Professor of Distinction in the College of Arts and Sciences at the University of Colorado Boulder. In 2013, he was named an Edward F. Adolph Distinguished Lecturer by the American Physiological Society for his work in the physiology of aging.

Daniel Craighead, PhD, is an Assistant Research Professor in the Department of Integrative Physiology at the University of Colorado Boulder. He earned his doctoral degree in Kinesiology from Penn State University in 2017, and completed a post-doctoral fellowship in the Integrative Physiology of Aging Laboratory at the University of Colorado Boulder in 2020. Dr. Craighead is a specialist in the study of IMST for lowering blood pressure. Dr. Craighead conducted the initial R21-supported clinical trial on IMST, upon which the new research project with Klein Buendel is based. The Small Business Technology Transfer (STTR) Phase I study is supported by the National Heart, Lung, and Blood Institute, and will design and assess the feasibility of a smartphone app for delivering an IMST program and improving blood pressure in midlife and older adults. The program will provide instruction and promote adherence to the IMST intervention. Ultimately, the app will provide for widespread dissemination and adoption of an innovative tool to easily lower blood pressure and reduce cardiovascular disease risk. Dr. Craighead also has been the Principal Investigator on a study assessing the efficacy of nicotinamide riboside, a dietary supplement, for lowering blood pressure and improving vascular function in older adults, among other research projects.

Social Media IN-SERVICE TRAINING for Responsible Alcohol Serving

Social Media IN-SERVICE TRAINING for Responsible Alcohol Serving

Among prevention strategies for driving while intoxicated (DWI), responsible beverage service (RBS) training has been effective in some cases. A research team from Klein Buendel and the Pacific Institute for Research and Evaluation (PIRE) reported on the results of a pilot project to create an in-service professional development social media component for the online evidence-based RBS training, WayToServe®, at the 46th Annual Research Society on Alcohol Scientific Meeting held in Bellevue, Washington on June 24-28, 2023.

In-service support beyond initial RBS training may counter management disinterest or resistance to RBS. A prototype of the WayToServe Plus in-service professional development social media component was produced by the authors. It contained 51 social media posts on advanced RBS skills training (such as home delivery), experienced servers supporting new servers (such as tips and tricks), professionalism (such as handling disruptive customer), and basic management procedures (such as house policies). Messages were intended to (a) increase confidence and motivation to implement RBS methods, (b) create a professional community of servers supporting RBS actions, and (c) prevent degradation of RBS skills and motivation. Thirty-six (36) posts contained text, graphics, and/or links, 14 had TikTok-style videos, and one presented an interactive learning activity from the WayToServe training.

One hundred eleven (111) alcohol servers who completed WayToServe training in New Mexico or Washington State participated in a 4-week pilot test. Participants were enrolled in either a Facebook private group with the WayToServe Plus feed and online posttest survey (n=60 servers) or in a control group with the posttest survey only (n=51 servers). WayToServe Plus posts were posted once a day, Monday to Friday. All servers in the WayToServe Plus group (100%) followed the feed for all 4 weeks; 83.3% viewed a post; and 46.7% reacted/commented on a post. WayToServe Plus servers expressed increased self-efficacy for RBS practices and response efficacy for RBS reducing DWI compared to control servers. Servers felt WayToServe Plus was appropriate and usable, and 77.9% were likely to use it in the future.

In-service professional development delivered over social media is feasible with alcohol servers and has the potential to maintain and support RBS techniques during intervals between state-approved RBS training.

This research was supported by a grant to Klein Buendel from the National Institute on Alcohol Abuse and Alcoholism (AA029364; W. Gill Woodall and David Buller, Multiple Principal Investigators). Additional authors on the conference poster include Dr. Robert Saltz from the PIRE Prevention Research Center in Berkley, California, and Ms. Lila Martinez from Klein Buendel.



Driving while intoxicated (DWI) remains a preventable source of morbidity and mortality in the United States. The Ignition Interlock Device (IID) requires a driver to blow into a breathalyzer installed in a vehicle to establish sobriety and reduces drunk driving while installed. The use of IIDs has become widespread. Most states now require DWI offenders to install IIDs in their cars. 

However, once IIDs are removed, DWI recidivism levels return to those similar to offenders who had no IID installed. The B-SMART app has been systematically developed for DWI offenders and their Concerned Family Members (CFMs) to extend non-intoxicated driving beyond the IID installation period. 

B-SMART Module Topics

  • Life with the Interlock – orientation to Ignition Interlock Devices
  • Family processes to support changes in drinking
  • Effective communication skills for families
  • Finding family activities that do not involve alcohol 

Results of a randomized trial of the B-SMART app on a variety of alcohol consumption, IID, and family communication variables were reported by Dr. W. Gill Woodall, Klein Buendel Senior Scientist, at the 46th Annual Research Society on Alcohol Scientific Meeting held in Bellevue, Washington on June 24-28, 2023.

Study participants, who were pairs of DWI Offenders and CFMs, were randomly assigned to receive the B-SMART web app or an available IID information page from the New Mexico Department of Transportation (Usual and Customary/UC condition). Participants were assessed at baseline, 3 months, and 9 months. 

Analyses of alcohol consumption variables yielded two results on alcohol quantity frequency with available data. For average drinks per day during the last 30 days at the 3-month assessment, a near significant between groups difference was detected such that client participants in the UC group reported significantly higher drinks per day when drinking than B-SMART intervention client participants. A second alcohol consumption effect was found for reported average drinks per week, where UC participants reported increasing average weekly drinking from baseline to 3-month follow-up, while intervention participants reported no significant change in average drinks per week from baseline to 3-month follow-up. Results suggest that the B-SMART app may improve outcomes for DWI offender families.

This research was funded by the National Institute on Alcohol Abuse and Alcoholism (AA022850; Dr. W. Gill Woodall, Principal Investigator). Dr. Woodall’s scientific collaborators include Dr. Barbara McCrady and Dr. Vern Westerberg from the University of New Mexico, and Ms. Julia Berteletti, Ms. Marita Brooks, and Ms. Lila Martinez from Klein Buendel.

IMST for Reducing High Blood Pressure

IMST for Reducing High Blood Pressure

Midlife and older adults exhibit a rapid increase in systolic blood pressure (SBP) which is associated with an increased risk for cardiovascular diseases. Researchers at the University of Colorado Boulder recently established the clinical efficacy of high-resistance inspiratory muscle strength training (IMST), a novel form of physical training with minimal barriers to adherence, for lowering SBP in midlife and older adults in a clinical trial with regular clinic-based, researcher-supervised training.

A new Phase I STTR project seeks to leverage the growing field of digital health technologies by taking the first steps in developing a feasible and acceptable smartphone app that independently guides users through a high-resistance IMST program, a key step to translate IMST for widespread use and improving public health.

The research grant has been awarded to Klein Buendel and will be led by experts in cardiovascular health, aging and high-resistance IMST from the University of Colorado Boulder (Dr. Douglas Seals, Principal Investigator; Dr. Daniel Craighead, Co-Investigator) and digital health technology development and delivery from Klein Buendel (Dr. Kayla Nuss, Co-Investigator). The one-year project will collect feedback and preferences from potential users to guide app development and demonstrate feasibility of such a mobile app.

Specific Aims

Aim 1: Perform iterative focus groups in midlife/older adults with above-normal SBP to collect potential-user information to identify needs and preferences for effective IMST app design.

Aim 2: Design the conceptual model and develop planned app components, including printed wireframes, storyboards, and clickable wireframes.

Aim 3: Conduct beta and usability testing on the clickable wireframes to show feasibility, acceptability, and potential for engagement, and finalize IMST app design.

Successful completion of this Phase I study will provide evidence to support programming and evaluating the full-scale IMST app in a subsequent Phase II project. If awarded, the Phase II project would directly compare the efficacy of at-home, self-guided IMST with the app vs. home BP monitoring alone (usual care control) for lowering SBP in a randomized clinical trial. The ultimate research goal of Phases I and II is to produce a commercially-ready mobile app for at-home implementation of high-resistance IMST, as a cost-effective lifestyle intervention for lowering SBP, decreasing disease risk, and reducing health care costs.

The research is supported by a grant from the National Heart, Lung, and Blood Institute at the National Institutes of Health (HL167375; Dr. Douglas Seals, Principal Investigator).