Results of the Pinpoint Project

Results of the Pinpoint Project

The Pinpoint web app was created and evaluated by Klein Buendel in collaboration with HPC International through a grant funded by the National Institute on Minority Health and Health Disparities (MD010746; Dr. Valerie Myers, Principal Investigator). Designed for adolescents aged 13-17, the Pinpoint web app provides education on communication strategies and sickle cell disease (SCD) care management. Pinpoint includes a pain assessment tool, vocabulary game, body scanner reflection, and educational self-disclosure activity. It was developed as an interactive gaming web app for use on smartphones, tablets, and desktop computers. Learning Buddies were added to act as a guide for the teen in the app to explain each activity and feature with text and voiceover. There are two Learning Buddy characters to choose from, each of whom had their own fictional story about living with SCD. Learning Buddies are customizable, allowing teen participants to choose clothing, hair style, and skin tone upon registering for the app. For each activity the teens participate in, points can be earned to unlock additional customization options, including hats, jewelry, and more hairstyles and clothing options. A Self-Disclosure Stories section was also added to the web app. This consists of stories from real people, including children, young adults, and older adults living with SCD.

The fully developed app was used to interview clinicians to evaluate content and clinical meaningfulness (n=10). Additionally, adolescents (n=11), aged 13-17, with SCD participated in usability testing to evaluate the user interface, ease of use, and perceived barriers. Both clinicians and teens participating in the usability study were encouraged to go through the app on their own while sharing their screen and describing aloud their thoughts and impressions of the app. They were then guided to specific parts of the app (such as the vocabulary game, self-disclosure activity, Pain Assessment Tool, Body Scanner Reflection, and Learning Buddies) to review.

Overall, clinicians believed the app content was meaningful and engaging, would help their patients better identify SCD pain and would help them better treat their patients’ pain. Clinicians also said they would encourage SCD patients to use the app. Teen participants in the usability testing found the app to be easy to use and understand. They enjoyed the interactivity of the games, found the Learning Buddy to be interesting and relatable, and liked that they could share the information recorded on the pain assessment tool with caregivers and healthcare providers by text or email.

In a subsequent randomized, stepped-wedge trial, the app was tested with 13–17-year-olds with SCD and one of their parents to evaluate changes in knowledge acquisition for communicating about pain. Community-based recruitment strategies were used. This involved attending SCD conferences, creating relationships with community-based organizations (such as sickle cell associations, sickle cell camps, libraries, Boys and Girls clubs, YMCAs, and clinics), online recruitment (such as Facebook/Reddit ads and posting in SCD-specific groups on Facebook/Reddit), partnering with companies that specialize in recruiting for SCD research, and snowball recruitment. Through these efforts, 24 teen/parent dyads were successfully recruited and randomly assigned to study group.

Both teens and their parent took a survey every 4 weeks for 12-16 weeks and used the app for 4-12 weeks, depending on which arm of the study they were assigned. Parents and teens randomized into Arms 1-3 took surveys every 4 weeks for 12 weeks and downloaded the Pinpoint app at Baseline (Arm 1; used the app for 12 weeks), 4 Weeks (Arm 2; used the app for 8 weeks), or 8 Weeks (Arm 3; used the app for 4 weeks), while participants in Arm 4 took surveys every 4 weeks for 16 weeks and downloaded the Pinpoint app at 12 Weeks (used the app for 4 weeks). Surveys were completed during a virtual check-in via Zoom with a member of the study staff. There was 100% retention of both parents and adolescents throughout the intervention for follow-up surveys.

Adolescents reported on pain interference, peer relationships, physical stress experiences, psychological stress experiences, pain behavior, pain quality, experiences with providers, family relationships, communication, and personal experiences with the SCD. Parents were assessed on disease knowledge, family relationships, family communication, and their experiences managing their child’s SCD. The adolescents were 92% African American, 8% Hispanic, 54% male, and the mean age was 14.8. SCD was not a new disease for any of the participants. The parents were 93% African American, 4% Hispanic, 92% female, and the mean age was 44.9. The small sample size prohibits the investigators from evaluating changes between groups, though summary statistics at each time point were created and reviewed.

In the final surveys, adolescents also reported on the usability of the web app:

At the baseline and the final survey time points, adolescents reported on communication and SCD pain management:

Lastly, web app usage data was collected. From the 24 adolescents randomized, 34 pain reports were entered by 16 unique users (67%) within the app. Of those pain reports recorded, 20 (59%) were shared with their parent or health care provider via the app.

Pinpoint is available to individuals and medical providers. To learn more about the Pinpoint app, check out the video tutorial or visit HPC International.

Collaborator Spotlight: New Mexico Investigators on the #4Corners4Health Project

Collaborator Spotlight: New Mexico Investigators on the #4Corners4Health Project

More than a dozen scientists from universities and NCI Comprehensive Cancer Centers in Arizona, Colorado, New Mexico, and Utah are collaborating with Dr. David Buller, Klein Buendel’s Director of Research, on the #4Corners4Health study (CA268037). This Collaborator Spotlight will feature the Investigators from the State of New Mexico.

The 4Corners study aims to aid rural emerging adults (ages 18-26 years) in making informed decisions that reduce cancer risk factors and prevent cancer later in life and help emerging adults evaluate and resist misinformation and marketing that promote cancer risk behaviors. This will be accomplished using a social media campaign designed with community advisors for diverse young adults living in rural counties in the Four Corners states (AZ, CO, NM, and UT). Social media may reach emerging adults more than interventions through other community channels (for example, clinics, schools, and workplaces) and for lower cost in the geographically-dispersed, underserved rural communities in the Mountain West.

Andrew Sussman, PhD, MCRP, is a medical anthropologist and an Associate Professor in the Department of Family Community Medicine and the  Associate Director for Community Outreach and Engagement at the University of New Mexico Comprehensive Cancer Center (Cancer Control and Population Sciences). At the Cancer Center, he served as the Founding Director of the Behavioral Measurement and Population Science Shared Resource.

Dr. Sussman has expertise in qualitative and mixed method research, formative assessment, and process evaluation. His research focuses on cancer care delivery research, patient-provider communication, clinical decision making, health service delivery, community-based participatory research, and health disparities in primary care and community settings. He has received funding to conduct research on cancer prevention, obesity and diabetes, substance use, and complementary and alternative medicine, among other topics.

In addition to research, he teaches and mentors students, and serves on several university committees, including evaluating the Physician Assistant Program in the Department of Family and Community Medicine and the Advancing Institutional Mentoring Excellence Program through the Office for Diversity.

Cindy Blair, MPH, PhD, is an epidemiologist and an Associate Professor in the Department of Internal Medicine at the University of New Mexico. She also has an appointment at the Comprehensive Cancer Center in Cancer Control and Population Sciences.

Dr. Blair’s research focuses on developing lifestyle behavior change interventions to improve the physical health and quality of life of cancer survivors. Her primary research interests include physical activity and the interface between aging and cancer, including interventions that utilize a whole-of-day approach to physical activity. This approach focuses on increasing light-intensity activity throughout the day, while reducing and disrupting sedentary activity. Her research includes the development of home- and technology-based interventions to reach the underserved and understudied survivor populations, especially older individuals from racial-ethnic minorities and rural dwellers, who may be unable to travel to clinical research centers to participate in research studies.

She has received a Career Development Award (K07) from the National Cancer Institute (2018-2023) and completed a Postdoctoral Research Fellowship (R25) with the National Cancer Institute Cancer Prevention and Control Training Program (2011-2013).

Sales of Alcohol to Apparently Intoxicated Customers in Three States

Sales of Alcohol to Apparently Intoxicated Customers in Three States

Most states prohibit sales of alcohol to customers who are apparently intoxicated. Many states require training in responsible beverage service, with the aim of reducing driving while intoxicated (DWI) and other harms.

Klein Buendel scientists and staff, along with a research collaborator from the Pacific Institute for Research and Evaluation, assessed alcohol sales to apparently intoxicated patrons across three states. Their findings were published in the Journal of Studies on Alcohol and Drugs.

A sample of 180 establishments licensed for on-site alcohol sales was selected in California (n=60), New Mexico (n=60), and Washington state (n=60). The three states had different RBS training histories, content, and procedures. Research confederates, trained to feign cues of alcohol intoxication, visited each establishment twice. The pseudo-intoxicated patron ordered an alcoholic beverage while displaying intoxication cues. Sale of alcohol was the primary outcome.

At 179 establishments assessed, the pseudo-intoxicated patrons were served alcohol during 56.5% of 356 visits (35.6% of establishments served and 22.6% did not serve at both visits). Alcohol sales were less frequent in New Mexico (47.9%) and Washington state (49.6%) than in California (72.0%). Servers less consistently refused service at both visits in California (6.8%) than New Mexico (33.9%) or Washington (27.1%). Alcohol sales were higher when intoxication cues were less obvious.

Over-service of alcohol to apparently intoxicated customers was frequent and likely elevated risk of DWI and other harms. The lower sales in New Mexico and Washington than California may show that a policy approach prohibiting sales to intoxicated customers combined with well-established RBS training can reduce over-service. The authors concluded that further efforts are needed to reduce over-service of alcohol to intoxicated patrons.

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). Collaborating authors include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in Berkley, California, Dr. Gary Cutter from the University of Alabama, and Ms. Lila Martinez, Ms. Annelise Small, and Mr. Noah Chirico from Klein Buendel.

Cancer Fatalism and Engagement with Skin Cancer Genetic Information

Cancer Fatalism and Engagement with Skin Cancer Genetic Information

A research team led by Dr. Jennifer Hay from Memorial Sloan Kettering Cancer Center in New York and Dr. Marianne Berwick from the University of New Mexico, and including Dr. David Buller from Klein Buendel, has published results from a study in Psycho-Oncology. The research paper is entitled, “Exploring the role of cancer fatalism and engagement with skin cancer genetic information in diverse primary care patients.”

Cancer fatalism is important in cancer prevention and deserves theoretical and empirical attention in the context of genomics and behavior change. This study was designed to broaden the currently limited reach of genomic innovations, and to help understand how psychosocial and cultural factors influence reactions to genetic testing in diverse subgroups.

The study employed data from a randomized controlled trial offering skin cancer genetic testing (using the melanocortin-1 receptor [MC1R] gene) to 593 people in primary care in Albuquerque, New Mexico. The authors examined interrelations of cancer fatalism with demographics, general health beliefs, perceived risk, perceived control, sun protection and skin screening behaviors, and cancer worry in the skin cancer context stratified across Hispanic versus non-Hispanic ethnicity. It examined cancer fatalism as a moderator of intervention effects on study primary outcomes, including 3-month sun protection, cancer worry, and perceived risk.

Cancer fatalism was significantly related to the perception of control over skin cancer risk behaviors and demographics (ethnicity, education, health literacy), but not consistently related to general health beliefs or risk perception. Cancer fatalism did not moderate intervention effects on primary outcomes, except that those with higher cancer fatalism randomized to intervention had higher levels of 3-month cancer worry. Study significance, methods, analyses are detailed in the Psycho-Oncology paper.  

These findings will guide future work considering the role of cancer fatalism in use of genomic technologies in the general population. This work anticipates strategies required to address cancer fatalism as translational genomics becomes more commonly available to diverse general population subgroups.

This research was supported by a grant from the National Cancer Institute (CA181241; Dr. Jennifer Hay and Dr. Marianne Berwick, Multiple Principal Investigators). Authors in addition to the Principal Investigators include Dr. Yelena Wu and Dr. Kimberly Kaphingst from the University of Utah; Ms. Elizabeth Schofield and Dr. Yuelin Li from the Memorial Sloan Kettering Cancer Center; Dr. Andrew Sussman, Dr. Dolores Guest, and Dr. Keith Hunley from the University of New Mexico; and Dr. David Buller from Klein Buendel.

iTRAC Emotion Regulation + Substance Use Prevention

iTRAC Emotion Regulation + Substance Use Prevention

Klein Buendel Investigators, Ms. Julia Berteletti and Dr. W. Gill Woodall, are collaborating with Dr. Chris Houck from Rhode Island Hospital and Dr. Stephanie Parade from Brown University on a new 5-year project to integrate substance use content with iTRAC emotion regulation material to reduce substance use among child welfare involved youth. The web-based intervention is being developed and evaluated in partnership with the Rhode Island Department of Children, Youth, and Families.

Nearly 700,000 children experience maltreatment each year, and youth with a maltreatment history are at heightened risk for substance use across the lifespan. Emotion regulation is a modifiable mechanism underlying the impact of maltreatment on risk behaviors but is often impaired in youth with a maltreatment history due to the neurotoxic effects of early trauma/neglect and inconsistent modeling of adaptive emotion regulation strategies. Emotion regulation is related to substance use in adolescence, and interventions to support the development of adaptive emotion regulation in youth with a maltreatment history have outstanding potential to interrupt trajectories of risk and prevent substance use. However, youth with a maltreatment history often face structural and psychosocial barriers to engagement. Furthermore, the child welfare system, which is designed to protect and support youth with maltreatment histories, is under resourced and often unable to meet the critical needs for prevention in this population. Interventions targeting substance use with this population must be acceptable, easily accessible, and low resource for the child welfare system.

During the Planning and Intervention Enhancement Phase (R61), the investigators will interview adolescents, caregivers, and child welfare professionals to obtain diverse perspectives regarding the integration of emotion regulation and substance use. They will create and program this content within the iTRAC framework, followed by acceptability testing to ensure usability and understanding. Upon completion of Phase 1, the team will begin Phase 2 (R33), during which a Stage III real-world efficacy (hybrid efficacy-effectiveness) trial of 200 youth with maltreatment histories will evaluate the iTRAC for Substance Use (iTRAC-SU) intervention.

Aim 2: To assess acceptability and usability with 10 adolescents (representing diverse backgrounds) over two iterative rounds of feedback.

Aim 3: To ensure successful completion of the Phase 2 Aims, planning activities with Rhode Island Department of Children, Youth, and Families. will take place to establish procedures for developing the workforce for the project, recruiting families, and avoiding interference by research in the critical mission of Department of Children, Youth, and Families programs.

Aim 4: To conduct a randomized controlled trial examining the impact of the iTRAC-SU intervention on substance use relative to a waitlist control among 200 adolescents ages 12 to 15.

Aim 5: To examine iTRAC-SU relative to a waitlist control in enhancing theoretically important emotional competencies (such as emotion regulation, emotion recognition, distress tolerance) that mediate risk as measured by self-report, performance measures, caregiver report, and respiratory sinus arrhythmia.

Aim 6: To examine the feasibility, acceptability, uptake, and costs of iTRAC-SU when implemented with child welfare involved youth.

This research project was awarded to the Rhode Island Hospital by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (DA059785; Dr. Chris Houck and Dr. Stephanie Parade, Multiple Principal Investigators). Collaborators include Ms. Julia Berteletti and Dr. W. Gill Woodall from Klein Buendel, and the Rhode Island Department of Children, Youth, and Families. The enhanced iTRAC modules will be designed and programmed by the Creative Team at Klein Buendel.

Just Care for Dementia in Prison

Just Care for Dementia in Prison

A research team from The Penn State University Ross and Carol Nese College of Nursing and Klein Buendel made two presentations related to formative research on the development of Just Care for Dementia at the 36th Annual Scientific Sessions of the Eastern Nursing Research Society April 4-5, 2024 in Boston, MA.

Title: Dementia Care Training Needs for Corrections Staff and Peer Caregivers

Dr. Susan Loeb, Penn State University

Presenter: Dr. Susan Loeb

The number of people living in prison with Alzheimer’s Disease and Related Dementias (ADRD) is growing. Care inequities for ADRD between prisons and community settings exist and warrant addressing. A standardized, evidence-based, feasible, and acceptable ADRD e-training program is needed to prepare corrections staff and peer caregivers for better managing and caring for people with ADRD in prisons. 

The purposes of this study were to (1) identify three priority learning needs of corrections staff and peer caregivers who manage and/or care for people living with ADRD in prisons; (2) identify a logo for the Just Care for Dementia training that was desirable to end-users; and (3) translate best practices from community-based ADRD care into evidence-based, accessible, and relevant ADRD content for prison settings. The end goal was to program prototypes for three highly interactive e-learning modules that fit within the restrictive context of corrections.

Focus group methodology guided potential future users in providing insights to ensure the content, design, and technology plans match the needs and constraints of prisons. Human subjects approvals were secured and participants’ signed informed consent was obtained. Settings were one men’s and one women’s state prison in the northeastern United States. Twelve corrections staff and 11 peer caregivers participated. Focus groups were audio recorded, transcribed, and deidentified.

Thematic analysis was completed independently by two researchers. The three priority content areas identified were fostering a safe and calm environment, addressing behavioral and psychological symptoms of dementia, and enhancing awareness of need. Participants identified two logo preferences. Advisory board consultation informed logo selection. Module content was developed via an iterative process to ensure contextual relevance of training, accessibility within the constraints of prisons, and the e-training matched identified training needs.

In summary, participants confirmed the need for ADRD training and indicated e-learning is a viable approach for addressing a pressing 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 from Penn State and Dr. Barbara Walkosz from Klein Buendel, Multiple Principal Investigators). Collaborators included Dr. Erin Kitt-Lewis and Sherif Olanrewaju from Penn State University; and Amanda Brice and Steve Fullmer from Klein Buendel. 

Title: Small-Scale Usability Testing: E-learning modules for Peer Caregivers 

Presenter: Dr. Susan Loeb

Growing numbers of people will grow old and die while incarcerated. Research evidence supports using peer caregivers to assist staff with geriatric and end-of-life care. Peer caregivers training varies widely in content and duration. Evidenced-based, accessible, and contextually relevant materials are needed to effectively prepare peer caregivers. 

The purpose of this study was to conduct research and development for Just Care, a six-module e-learning program for peer caregivers and a single module to guide corrections staff in launching the program. Deputy Wardens identified people meeting our inclusion criteria. Nineteen people living in prison and 11 staff participated. Throughout usability testing, participants shared their thoughts aloud, while field notes were taken. Participants completed six open-ended questions, a demographic survey, and the System Usability Scale (SUS).

All users easily navigated through the program with minimal guidance. Many noted Just Care’s utility for future peer caregivers. Some users who were incarcerated had difficulty navigating the post-test assessments. 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. Just Care received Round 1 SUS scores of 87.5 by users living in prison and 74.5 by staff. Following rapid refinement, Just Care received Round 2 mean SUS scores of 85.28 by users living in prison and 83.75 by staff. A SUS score of 68 is an above average score.

Overall, participants found Just Care innovative, useful, engaging, interactive, and relevant to providing geriatric and end-of-life care in prisons. Staff noted that Just Care raised awareness about the growing need for programming on geriatric care in prisons and that a peer caregiver program is a viable solution that is implementable by prison staff.  

This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging (AG057239; Dr. Susan Loeb from Penn State and Dr. Barbara Walkosz from Klein Buendel, Multiple Principal Investigators). Collaborators included Dr. Erin Kitt-Lewis and Sherif Olanrewaju from Penn State University; and Brandon Herbeck, Peter Fu, and Steve Fullmer from Klein Buendel. 

Project SHINE Protocol

Project SHINE Protocol

A research team led by Dr. Yelena Wu from the University of Utah and the Huntsman Cancer Institute, and including Dr. David Buller from Klein Buendel, has published a detailed protocol for the project entitled, “Sun-safe Habits Intervention and Education” in Contemporary Clinical Trials. Project SHINE examines the efficacy of a personalized intervention targeting sun protection and tanning of high school students.

Adolescents infrequently use sun protection and engage in intentional tanning more frequently compared to other age groups, leading to increased ultraviolet radiation (UVR) exposure that heightens skin cancer risk across the lifespan. High schools are therefore an ideal setting for offering skin cancer prevention interventions. Yet, there are limited UVR protection interventions for high school students, especially those that are personalized, tested using randomized designs, and include long-term outcome assessment to determine the durability of intervention effects.

The SHINE cluster-randomized trial will test a novel, personalized intervention that targets high school adolescents’ sun protection and tanning behaviors, and tracks their outcomes for up to one year following intervention. Enrolled high schools will be randomized to receive either the personalized SHINE intervention, which includes facial UVR photographs and sun protection action planning, or standard education using publicly available materials. Students in both conditions will receive information about skin cancer, sun protection, and skin self-examination. Outcome variables will include students’ sun protection and tanning behaviors and sunburn occurrence. Potential moderators (such as race/ethnicity) and mediators (such as self-efficacy) will also be assessed and tested.

The investigators believe Project SHINE will lead to new scientific understanding of the theoretical mechanisms underlying outcomes and moderators of the intervention effects, which will inform future intervention tailoring to meet the needs of vulnerable subgroups.

This research is sponsored by the National Cancer Institute (Dr. Yelena Wu from the University of Utah and the Huntsman Cancer Institute, Principal Investigator). Dr. David Buller, Director of Research at Klein Buendel, is a Co-Investigator.

Indoor Tanning Policies Are Insufficient to Protect Young Adults

Indoor Tanning Policies Are Insufficient to Protect Young Adults

Ms. Anna Mitarotondo, a Research Program Manager from Rutgers University, gave a Research Spotlight presentation on the Indoor Tanning Policy research project at the 45th Annual Sessions and Meeting of the Society of Behavioral Medicine in Philadelphia, PA, March 13-16, 2024. Dr. Carolyn Heckman from Rutgers and Dr. David Buller from Klein Buendel are the project’s Multiple Principal Investigators.

Ms. Anna Mitarotondo, Rutgers University

Five million Americans are treated for skin cancer annually with the incidence of melanoma tripling in the last 40 years. Even a single session of indoor tanning is a well-established cause of melanoma especially at younger ages. Indoor tanning is also associated with sunburn, another major risk factor. In addition to FDA safety regulations, 46 states restrict minor indoor tanning access. More stringent laws (such as age bans vs. parental consent or no law) have been associated with less youth indoor tanning. However, enforcement and compliance are essential for successful law implementation. This study investigates regulation stringency, behavior, facility compliance, and sunburns.

The research team conducted an online, nationally representative survey of 1000 individuals aged 18-29 who indoor tanned in the last three years. 82% identified as female, and 74% as white, non-Hispanic. A majority (89%)  indoor tanned multiple times in the past three years. Participants reported being most likely to tan in indoor tanning salons, gyms, and beauty salons. They also reported indoor tanning in homes, spas, and apartment complexes, with participants indoor tanning in more types of facilities after age 18. Despite FDA recommendations, participants reported that only 16% of facilities prohibited daily or unlimited tanning. Nearly half (48%) of participants were not informed of time limits when indoor tanning. Half (50%) reported that over half of the time, they were able to avoid indoor tanning facility rules. Nearly two-thirds (61%) of participants reported burning from an indoor tanning device in the past three years, with 15% reporting a burn from their most recent session. Of participants who reported indoor tanning as minors, 61% reported burns and 30% reported getting medical attention.

This is the first study to show rates of indoor tanning at facilities other than tanning salons, both before and after age 18, in a representative national sample. Participants reported insufficient facility compliance with, and enforcement of, indoor tanning regulations, which in some cases may have led to severe burns. Analyses are underway to further investigate regulation stringency, enforcement, and compliance by type of facility and state, adjusting for demographic factors and additional key covariates. The goal is to inform future indoor tanning policies at the state and federal level.

This research was supported by a grant to Rutgers from the National Cancer Institute (CA244370; Dr. Carolyn Heckman and Dr. David Buller, Multiple Principal Investigators). Coauthors included and Ms. Maame Araba Assan from Rutgers University, Dr. Jerod Stapleton from the University of Kentucky, and Ms. Julia Berteletti from Klein Buendel.

Physical Activity, Motivation, and Social Media Content

Physical Activity, Motivation, and Social Media Content

Klein Buendel Scientist, Dr. Kayla Nuss, and her collaborators presented two groundbreaking posters on physical activity and exposure to social media physical activity content at the 45th Annual Sessions and Meeting of the Society of Behavioral Medicine in Philadelphia, PA, March 13-16, 2024. The research delved into three types of physical activity content: fitspiration, body positivity, and body neutrality.

Title: Associations Between Exposure to Fitspiration, Body Positive, and Body Neutral Social Media Content and Physical Activity Engagement: A Cross-Sectional Analysis

Dr. Kayla Nuss

Presenter: Dr. Kayla Nuss

In 2021, nearly 70% of Americans reported using social media, a statistic that has remained fairly constant since 2016. The fitspiration trend, which has become increasingly popular on most social media platforms, encourages users to share fitness inspiration content, including health and fitness tips and motivational posts. However fitspiration exposure has no significant effect on physical activity (PA) intentions or engagement.1

The body positivity movement emerged as a direct response to fitspiration, featuring a range of diverse body sizes and types, including fat and plus-sized influencers engaging in activities. Evidence indicates that exposure to body positive content is associated with greater intentions for physical activity and increased engagement when compared to fitspiration content. A third social media movement, body neutrality, focuses on the functionality and appreciation of the body for not how it looks, but rather what it can do. To our knowledge, no study has explored the association between body neutrality exposure and PA engagement. As such, the purpose of this study is to assess the associations among exposure to fitspiration, body positive, and body neutral social media content and PA behavior.

Two-hundred and thirty-seven (237) participants responded to a survey that included the validated Global Physical Activity Questionnaire (GPAQ) to assess weekly moderate to vigorous PA (MVPA) and sedentary time. In addition, the authors assessed participants’ exposure to social media fitspiration, body positive, and body neutral content. During data cleaning, they categorized exposure to the three content types into “no exposure,” “low exposure,” “moderate exposure”, and “high exposure”. The authors also collected demographic and anthropomorphic data. Using a series of analyses of variance tests, they investigated associations among different levels of exposure to fitspiration, body positive, and body neutral content, and PA engagement. 

Biological sex had a significant main effect on weekly minutes of MVPA, and was included it in the models. Exposure to fitspiration had no significant effect, but exposure to both body positive content and body neutrality content did. Post-hoc comparisons revealed that in both contexts, participants who reported high exposure to either body positive or body neutral content had significantly more minutes of weekly MVPA than those who reported no exposure levels and low exposure levels, respectively.

The authors concluded that whereas fitspiration content is intended to inspire physical activity and fitness, there is no association between it and engagement. Interventionists may consider creating programs leveraging body positive or body neutral content to increase PA among social media users.

This research was sponsored by Klein Buendel and led by Dr. Kayla Nuss. Coauthors included Dr. Dani Arrigo from Rowan University and Ms. Julia Berteletti from Klein Buendel.

Title: Interaction Effects of Amotivation for Physical Activity and Fitness Social Media Exposure on Physical Activity Intentions

Presenter: Dr. Kayla Nuss

Nearly half of Americans seek fitness, physical activity (PA), and health advice from social media platforms like Facebook and Instagram. Further, nearly 20% have changed a component of their wellness regimen based on that advice. There are three main categories of physical and activity content on social media, each with its own content themes:

  • Fitspiration features mostly white, thin, Women, unengaged in PA and has no discernable association with motivation or PA engagement.1
  • Body positive content features diverse bodies, including fat and plus-sized influencers engaged in PA, and has been associated with greater intentions for PA. Associations with motivation and engagement are unknown.
  • Body neutrality is centered on the functionality of the body, rather than appearance.

To date, no study has examined its associations with PA motivation, intention, or engagement. The purpose of this study is to examine cross-sectional associations of exposure to fitness social media content with Self-Determination Theory motivational subtypes, and PA intention and engagement.

A total of 237 participants responded to a survey that included the validated Global Physical Activity Questionnaire (GPAQ) to assess weekly moderate to vigorous PA (MVPA). The authors examined intention for PA using the Behavioral Intentions Scale and assessed motivation for PA using the Behavioral Regulations in Exercise Scale. The authors also assessed participants’ exposure to social media fitspiration, body positive, and body neutral content. They categorized exposure to the three content types into “no exposure,” “low exposure,” “moderate exposure”, and “high exposure.” They also collected demographic and anthropomorphic data. Using a series of analyses of variance tests, the authors investigated associations among different levels of exposure to fitspiration, body positive, and body neutral content, and motivation, PA intention, and engagement.  

For the reporting of results, the authors first examined interaction effects between exposure to fitness content and each of the motivational subtypes on PA intention and behavior. They identified a significant interaction of amotivation (having no drive for the behavior) and exposure to both fitspiration and body positive content on PA intentions, but not engagement. Specifically, highly amotivated individuals who also reported high exposure to these social media types reported greater intentions for PA than those who reported moderate, low, or no exposure. There was no significant interaction effect between amotivation and body neutral exposure on PA intentions nor engagement.

The authors concluded that interventionists may consider exposing highly amotivated individuals to fitspiration or body positive social media to potentially increase intentions for PA. However, the intention-behavior gap must also be addressed in this population.

This research was sponsored by Klein Buendel and led by Dr. Kayla Nuss. Coauthors included Dr. Dani Arrigo from Rowan University and Ms. Julia Berteletti from Klein Buendel.

References

  1. Nuss K, Coulter R, Liu S. Content of social media fitspiration and its effect on physical activity-related behavior: A systematic review. Psychology of Popular Media. Published online 2023.
#4Corners4Health: Protocol for a Randomized Stepped-Wedge Trial

#4Corners4Health: Protocol for a Randomized Stepped-Wedge Trial

Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico are leading a large multiple state research team on the design, implementation, and evaluation of #4Corners4Health. The research study aims to decrease cancer risk factors among emerging adults (ages 18-26) living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah using a targeted social media campaign. The team has published a full description of their study procedures in JMIR Research Protocols.

Many emerging adults are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among emerging adults delivered over social media is limited. Cancer prevention information and recommendations may reach emerging adults more effectively over social media than in settings such as health care, schools, and workplaces, particularly for emerging adults residing in rural areas.

Specifically, the research team will recruit a sample of 1000 emerging adults aged 18 to 26 years residing in rural counties in the Four Corners states from the Qualtrics’ research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and HPV vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and emerging adults and focus groups with emerging adults. The emerging adults will complete assessments at baseline and five additional data after randomization. Assessments will measure six cancer risk behaviors, theoretical mediators, and participants’ engagement with the social media campaign.

The trial is being led by a steering committee. Team members are working in three subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by emerging adults, and community resources available. A framework for the social media intervention with topics, format, and theoretical mediators has been created, along with protocols for social media management.

In summary, the researchers believe that social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among emerging adults. Because of the popularity of web-based information sources among emerging adults, an innovative, multiple risk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

This research is supported by a 5-year R01 grant from the National Cancer Institute (CA268037) to Klein Buendel. Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico are the project’s Multiple Principal Investigators. The JMIR publication has 24 collaborating authors from multiple institutions.