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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.

Phase 1 – Planning and Intervention Enhancement (R61) Specific Aims

Aim 1: To create and integrate digital content linking substance use with ER into existing iTRAC modules. Information gathered via qualitative interviews with adolescents, caregivers, and staff in the child welfare system will be used to develop the substance use content.

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.

Phase 2 – Randomized Trial (R33) Specific Aims

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.

Presentation 1

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. 

Presentation 2

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.

Poster 1

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.

Poster 2

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.

Usability Evaluation of the ezParent Administrative Dashboard

Usability Evaluation of the ezParent Administrative Dashboard

A team from Ohio State University and Klein Buendel has published results from the usability testing of the ezParent administrative dashboard in JMIR Formative Research. ezParent is a web-based training program for parents of children ages 2-6 years. It provides behavioral training through brief videos, interactivity, reflection questions, and assessments to parents of young children. 

Web-based parent training programs can strengthen parent-child relationships. They can help equip caregivers with knowledge and evidence-based strategies to manage behavior. They also can help surmount some logistical and personal barriers of in-person parent training. Web-based administrative dashboards provide administrators, facilitators, researchers, and others with detailed information about their participants’ usage, which can strengthen delivery of the intervention. Despite the utility of administrative dashboards, the authors know of no other research studies that have explored the perspectives and insights of dashboard users.

The study described in JMIR Formative Research used a descriptive, single-group survey design with four administrators who were overseeing implementation of the ezParent program and 19 trained facilitators for hybrid ezParent delivery. Participants were instructed to spend 30 minutes reviewing and assessing the ezParent dashboard and then prompted to complete a survey of their interaction with it. The survey included the validated 10-item System Usability Scale (SUS) and some open-ended questions.

Fifteen respondents indicated high usability of the ezParent dashboard, with a total mean SUS score of 83.5. Most participants (87%) rated the user-friendliness of the dashboard as good (20%), excellent (60%), or best imaginable (7%). Open-ended questions revealed the dashboard would be useful to monitor parent progress (40%), communicate with parents (13%), to review topics for discussion (20%), and to identify trends in parent participation (13%). ezParent administrators identified real-time data for ezParent users helps overall management of program uptake. Suggestions for features to add to the dashboard included the ability to track partial progress of program modules (29%), total time spent per module (14%), and exportable reports (7%). Other ideas for improvement included direct messaging capabilities, video-conferencing platform integration, and the ability to modify participant account and contact information.

Results indicate that the dashboard is easy to use and provides functional information to facilitators and administrators in delivering ezParent. Providing resources to aid in facilitation of the hybrid intervention may foster improved parent uptake and outcomes. Integrating suggested features into the dashboard may help provide a smoother experience for facilitators, administrators, and parents using the program.

This research was sponsored by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD104072; Dr. Susan Breitenstein, Principal Investigator, Ohio State University). Collaborating authors include Ms. Julia Berteletti and Mr. Charlie Barger from Klein Buendel; and Shea Smoske, Kyrie Tipps, and Nathan P. Helsabeck from The Ohio State University. The ezParent web-based program and administrative dashboard were programmed by the Creative Team at Klein Buendel.

Professional Development to Improve Responsible Beverage Service Training 

Professional Development to Improve Responsible Beverage Service Training 

Research collaborators from Klein Buendel and the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE) have published formative research results and a protocol for a randomized controlled trial in JMIR Research Protocols.  

The full trial will be evaluating an addition to a responsible beverage service (RBS) training because improved interventions are needed to reduce the rate of driving while intoxicated. RBS training has reduced service to intoxicated patrons in licensed premises in several studies. Its efficacy might be improved by increasing the proper application and continued use of RBS with a professional development program in the 3 to 5 years between the required RBS retraining. 

The formative research published in JMIR Research Protocols reports on the addition of a professional development component to an existing RBS training to improve the effectiveness of the web-based training alone. Semi-structured interviews with owners and managers of licensed establishments and focus groups and a survey with alcohol servers in New Mexico and Washington State were conducted to examine support for RBS and the need, feasibility, acceptability, and potential effectiveness of ongoing professional development. A prototype of a professional development component, WayToServe Plus, was produced and delivered in social media posts on advanced RBS skills, support from experienced servers, professionalism, and basic management training. The prototype included 50 social media posts. The prototype was evaluated in a usability survey and a field pilot study with alcohol servers in California, New Mexico, and Washington.  

Although owners and managers and alcohol servers were favorable toward RBS, they endorsed the need for ongoing support for RBS for servers and identified topics of interest. Servers felt that the professional development component was highly usable and appropriate for themselves and the premises in the usability survey (n=20) and field pilot test (n=110), with 85% and 78%, respectively, saying they would use it. Servers receiving the professional development component had higher self-efficacy and response efficacy for RBS compared with untreated controls. 

The article also includes a protocol for a planned randomized controlled trial. This phase of the project will include full production of the professional development component. It will be delivered in Facebook private groups over 12 months and evaluated with a sample of licensed premises (bars and restaurants) in California, New Mexico, and Washington (n=180) in a 2-group randomized field trial (WayToServe training only compared to WayToServe training and WayToServe Plus). Licensed establishments will be assessed for refusal of sales to apparently intoxicated pseudo-patrons at baseline and 12 months after the intervention commences. 

Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed premises. Servers were interested in using such a program, a large majority engaged with a prototype, and servers receiving the prototype improved on theoretic mediators of RBS. The authors believe that the professional development component may improve RBS training and save lives. 

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 on the paper include Dr. Robert Saltz from the PIRE Prevention Research Center in Berkley, California, and Ms. Lila Martinez from Klein Buendel. 

Serving Alcohol to Obviously Intoxicated Patrons

Serving Alcohol to Obviously Intoxicated Patrons

Klein Buendel scientists and staff are co-authors on a new publication of research results with scientists from the Pacific Institute for Research and Evaluation (PIRE) in the Journal of Studies on Alcohol and Drugs (JSAD). The study, led by PIRE, examines alcohol over-service at bars, nightclubs, restaurants, etc. in California which is associated with driving while intoxicated, violence, and other problems.

Three hundred licensed bars, night clubs, restaurants, etc. were sampled in 2022 in nine counties representing the San Francisco Bay Area. Combination pseudo-patron and observer teams visited each on-premise establishment where the pseudo-patrons attempted to buy alcohol while displaying obvious signs of intoxication. The JSAD paper describes characteristics of the establishments, servers, pseudo-patrons, and time/date of purchase attempt that may be associated with the refusal of alcohol service.

In total, 21% of the establishments refused alcohol service to pseudo-patrons. Descriptive and regression analyses were conducted and are described in detail in the JSAD publication. According to the authors, “No establishment or server characteristics were significantly associated with service refusal in logistic regression analysis; nor were month, day, or time.” However, service refusal was significantly more likely for female pseudo-patrons and pseudo-patrons displaying obvious or very obvious signs of intoxication.

The authors assert that the study indicates that alcohol over-service to obviously intoxicated patrons remains common at licensed on-premises establishments. Mandatory responsible beverage service training of servers and enforcement of alcohol over-service laws was recently enacted in California, which may help to reduce over-service and its related problems.

This study is sponsored by a grant from the National Institute on Drug Abuse (AA028772; Dr. Robert Saltz, Principal Investigator, PIRE). Co-authors include Dr. Mallie Paschall and Dr. Sharon O’Hara from PIRE, and Dr. W. Gill Woodall, Dr. David Buller, and Ms. Lila Martinez from Klein Buendel.  

2023 Research Highlights

2023 Research Highlights

Klein Buendel scientists and staff continued to pursue rigorous behavioral science research with numerous national and international collaborators. Our creative team also designed and engineered multiple web-based programs to positively impact the health and safety of people’s everyday lives.  

In 2023, we started three new research projects with diverse collaborators. We published (or e-published ahead of print) six research papers in peer-reviewed journals and six additional publications are in press for early 2024. We presented research analyses and outcomes at six national or international conferences.  

In March, Ms. Marita Brooks retired from Klein Buendel after working with Dr. Gill Woodall for over 30 years at the University of New Mexico (CASAA) and Klein Buendel (as a Senior Research Project Coordinator).  

In April, we hosted Ron Borland, PhD, FASSA, Professor of Psychology and Health Behavior from the University of Melbourne in Victoria, Australia. His focal presentation was entitled, “Can we eliminate smoking without embracing harm reduction?” 

In May, Dr. David Buller was a speaker at the 7th Annual Conference of the UCONN Center for Health and Social Media. His presentation was entitled, “How can public health better utilize social media? Challenges and opportunities.”  

In October, Dr. Buller participated in a panel discussion on measures, data sources, and data collection strategies at the New York University Policy-Focused Implementation Science Training. He discussed his research on responsible vendor practices and training in state-regulated alcohol markets aimed at reducing DUI and other harms of over-service of alcoholic beverages. 

In October, Dr. Buller also joined Carolyn Heckman from Rutgers University to present an update and preliminary findings from an investigation of state indoor tanning laws to the National Council for Skin Cancer Prevention. The presentation covered the nature of state laws, the political process that led to their passage or failure, and compliance with state regulations pertaining to minor access and other regulations on indoor tanning facilities. 

In December, Dr. Gill Woodall gave a presentation to the New Mexico Immunization Coalition. The presentation reviewed the effectiveness of the TeenVac web app on improved HPV vaccine uptake. 

Projects Launched in 2023 

  1. “Feasibility and design of a novel smartphone app to deliver blood pressure-lowering inspiratory muscle strength training.” Phase I STTR grant to Klein Buendel from the National Heart, Lung, and Blood Institute (HL167375; Dr. Douglas Seals, Principal Investigator, University of Colorado). The primary Co-Investigator from Klein Buendel is Dr. Kayla Nuss. 
  1. “Policy and training intervention in responsible marijuana sales practices to reduce the risk of selling to intoxicated customers.” A 5-year R01 grant from the National Institute on Alcohol Abuse and Alcoholism (AA031591; Dr. W. Gill Woodall and Dr. David Buller, Multiple Principal Investigators).  
  1. “Beyond Blame: Development of an online media literacy curriculum for violence prevention.” A Phase I SBIR grant from the Centers for Disease Control and Prevention (CE003635; Dr. Barbara Walkosz, Principal Investigator).  

For these new projects, we are collaborating with the following primary investigators, universities, and organizations: 

  • University of Colorado, Boulder (Dr. Douglas Seals) 
  • Pacific Institute for Research and Evaluation (Dr. Robert Saltz) 
  • NORC at the University of Chicago ((Mr. Jim Fell) 
  • Center for Media Literacy (Ms. Tessa Jolls) 

2023 Publications* 

  1. Manne S, Pagoto S, Peterson S, Heckman C, Kashy D, Berger A, Studts C, Megron R, Buller D, Paddock, Gallo, Kulik A, Frederick S, Pesanelli M, Domider M, Grosso M. Facebook Intervention for Young-Onset Melanoma Survivors and Families: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2023 Jan 24;12:e39640. 
  1. Ray AE, Mun E, Lewis MA, Litt DM, Stapleton JL, Tan L, Buller DB, Zhou Z, Bush HM, Himelhoch S. Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students: Protocol for a Hybrid Type 1 Effectiveness-Implementation Trial. JMIR Res Protoc. 2023 Mar 20:12:e43986. doi: 10.2196/43986. 
  1. Nuss K, Sui W, Rhodes R, Liu S. Motivational Profiles and Associations With Physical Activity Before, During, and After the COVID-19 Pandemic: Retrospective Study. JMIR Form Res. 2023 Apr 24;7: e43411. doi: 10.2196/43411. 
  1. Nuss K, Moore K, Marchant T, Courtney JB, Edwards K, Sharp JL, Nelson TL, Li K. The combined effect of motivational interviewing and wearable fitness trackers on motivation and physical activity in inactive adults: A randomized controlled trial. J Sports Sci. 2023 Mar 25:1-11. doi: 10.1080/02640414.2023.2195228. 
  1. Moore KN, Nuss K, Do B, Wang SD, Li K, Graham DJ, Dunton GF, Courtney JB. Motivational Profile as a Predictor of Physical Activity Among US Adults During the Early Months of the COVID-19 Pandemic: A Daily Diary Study. J Phys Act Health. 2023 Jul 28;20(10):963-970. doi: 10.1123/jpah.2022-0474. 
  1. Saltz R, Pashcall MJ, O’Hara S, Buller DB, Woodall WG, Martinez L. Serving alcohol to an “obviously intoxicated” patron. J Stud Alcohol Drugs. 2023 Dec 11. doi: 10.15288/jsad.23-00253. Online ahead of print. 

*KB investigators and staff are indicated in bold type  

2023 Conference Presentations 

Research progress, analyses, and outcomes were presented and disseminated by Klein Buendel scientists, staff, and their collaborators at the following national and international conferences in 2023: 

  • EUROGIN International Multidisciplinary HPV Congress (February)  
  • 44th Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine (April) 
  • 46th Annual Scientific Meeting of the Research Society on Alcoholism (June) 
  • Custody and Caring: 18th Biennial International Conference on the Nurse’s Role in the Criminal Justice System (September) 
  • 14th Conference of the European Society for Prevention Research (October) 
  • 16th Annual Conference on the Science of Dissemination and Implementation in Health (December)