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Dissemination & Implementation Conference

Dissemination & Implementation Conference

Three occupational sun safety projects were presented by collaborating researchers from Klein Buendel and Emory University at the 16th Annual Conference on the Science of Dissemination and Implementation in Health held December 10-13, 2023, in Washington, DC. Each presentation complemented the conference theme of “Raising Expectations for Dissemination & Implementation Science: Challenges and Opportunities,” by approaching occupational skin cancer prevention in a unique and challenging way.  

Poster 1 

Title: Differences in Program Implementation and Sun Protection of an Occupational Sun Safety Intervention: Comparison of Two Dissemination Strategies 

Presenter: Dr. David Buller, Klein Buendel 

Dr. David Buller

Balancing effectiveness and cost is essential when scaling up evidence-based interventions. In this study, two methods for disseminating an evidence-based occupational sun protection intervention that differed in cost and personal contact were compared. Solar ultraviolet radiation is a carcinogen associated with skin cancer. 

Sun Safe Workplaces (SSW), a policy and education intervention, was effective in a randomized trial in Colorado (1,2). Two methods for disseminating SSW were compared in a randomized pretest-posttest two-group trial design. State departments of transportation (DOTs; n=21) participated and the 136 districts within these DOTs were randomly assigned to receive SSW either by an in-person coaching method or a virtual coaching method. In each district, managers were pretested prior to randomization (n=1,484) and posttested (n=289) after 29-40 months (timing and attrition were affected by the COVID pandemic) on implementation of SSW training and communication and personal sun protection practices. Employees (n=1,388) also were posttested on training and communication implementation and personal sun protection practices. 

There was no difference in managers’ reported implementation of sun protection actions at the workplace between dissemination methods. But more employees reported receiving sun protection training in in-person (60%) than virtual (46%) dissemination method and being more favorable toward this training (in-person M=3.70, virtual M=3.60.) Managers at workplaces receiving SSW via in-person dissemination experienced fewer sunburns in the past year while working outdoors than with virtual program delivery (M=0.69 v. M=1.58 sunburns; estimate=-0.875, p<0.011), especially at workplaces receiving it before the pandemic compared to later in the pandemic (in-person=0.43, virtual=0.79). 

Effectiveness of evidence-based programs when scaled-up may be affected by the method of dissemination. Here, in-person coaching may have increased implementation of SSW training. It also may have aided coaches in convincing managers that there was a need for occupational sun safety and motivated them to avoid sunburn themselves and work to make employees see the value in training. The virtual delivery method may not have affected employees’ personal protection because they had limited contact with the coaches. Pandemic restrictions may have reduced intervention success. 

This research was supported by a grant (CA210259; Dr. David Buller, PI) from the National Cancer Institute at the National Institutes of Health. Coauthors on this poster presentation included Ms. Julia Berteletti and Ms. Mary Buller from Klein Buendel; Dr. Kimberly Henry from Colorado State University; Dr. Richard Meenan from Kaiser Permanente, and Dr. Gary Cutter from the University of Alabama. 

References 

  1. Buller, D. B., Walkosz, B. J., Buller, M. K., Wallis, A., Andersen, P. A., Scott, M. D., Eye, R., Liu, X., & Cutter, G. R. (2018). Results of a randomized trial on an intervention promoting adoption of occupational sun protection policies. American Journal of Health Promotion, 32, 1042-1053. 
  2. Walkosz, B. J., Buller, D. B., Buller, M. K., Wallis, A., Meenan, R., Cutter, G., Andersen, P. A., & Scott, M. D. (2018). Sun safe workplaces: Effect of an occupational skin cancer prevention program on employee sun safety practices. Journal of Occupational and Environmental Medicine, 60, 900-997. 

Presentation 1 

Title: Adaptation of an Evidence-based Occupational Sun Safety Program for Underserved Outdoor Workers in Southwest Georgia

Presenter: Dr. Alex Morshed, Emory University 

Dr. David Buller, Ms. Mary Buller, Dr. Alex Morshed, Dr. Cam Escoffery

African American and Hispanic workers face unique skin cancer risks from UV exposure and are underrepresented in occupational sun safety research. This presentation reported on adaptation of an existing evidence-based sun safety program—Go Sun Smart at Work—to predominantly African American and Hispanic outdoor workers in local government employers in Southwest Georgia. The adaptation is renamed Go Sun Smart Georgia.

The systematic adaptation process was informed by Dr. Cam Escoffery’s Key Adaptation Steps (1), Implementation Research Logic Model (IRLM) (2), and the Framework for Reporting Adaptations and Modifications (3). The original intervention promotes workplace policy and education to improve sun protection and was effective in a randomized trial in Colorado (4,5). The team mapped the program and delivery using IRLM and developed an adaptation tracking tool based on Rabin et al. (6) to catalogue and make decisions about potential adaptations. The team integrated multiple sources of information to identify compatible and feasible adaptations: consultation with program experts and community partners, qualitative data collection with outdoor workers and managers at two local government employers (Jul-Sep 2023), and synthesis of literature. 

The intervention includes training of peer coaches; written audit of employer sun safety policies, practices; employee training; and resource website (for example: training, sample policies, print materials, videos). In a pilot study with two local government employers, 11 employees identified by senior managers completed virtual 30-minute instruction to be peer coaches. Peer coaches delivered the sun safety training at staff meetings (21-39 employees per session). Several promising adaptations were identified, including modification of educational materials to better represent the worker population, addressing misconceptions, and use of external peer coaches at the workplace. Interviews with managers and focus groups with employees are in process.  

Adaptation of existing, effective interventions to better address population characteristics and needs can increase feasibility and scalability with employers throughout Georgia, which furthers dissemination and reach of existing evidence base for improving occupational sun safety and preventing cancer. 

This research was supported by a grant (U48DP006377) from the Centers for Disease Control and Prevention to the Emory University Prevention Research Center (Dr. Alex Morshed from Emory University and Dr. David Buller from Klein Buendel, MPIs). Coauthors on this oral presentation included Ms. Mary Buller, Dr. Barbara Walkosz, Ms. Irene Adjei, Mr. Brandon Herbeck, and Dr. David Buller from Klein Buendel; and Ms. Kayla Anderson, Dr. Cam Escoffery, and Radhika Agarwal from Emory University. 

References 

1.Escoffery et al. 2019. https://doi.org/10.1093/tbm/ibx067 

2.Smith et al. 2020. https://doi.org/10.1186/s13012-020-01041-8 

3.Wiltsey Stirman et al. 2019. https://doi.org/10.1186/s13012-019-0898-y 

4.Buller et al. 2017. https://doi.org/10.1177/0890117117704531 

5.Walkosz et al. 2018. https://doi.org/10.1097/JOM.0000000000001427 

6.Rabin et al. 2018. https://doi.org/10.3389%2Ffpubh.2018.00102 

Poster 2  

Title: “Technology for Workplace Implementation of Solar Radiation Safety in Response to Climate Change” 

Presenter: Ms. Mary Buller, Klein Buendel 

Ms. Mary Buller

The sun’s energy is both life-saving and life-threatening. Americans who work outdoors are exposed to rising temperatures and extreme levels of ultraviolet radiation from the sun. These exposures, without preventive measures, can cause heat illness, skin cancer, and death. It is estimated that solar radiation contributed to over 350,000 deaths from excessive heat in 2019 and over 120,000 deaths from skin cancer in 2020. The U.S. government recently launched an interagency effort to combat extreme heat, including for persons who work outdoors, and the Surgeon General has identified occupational sun safety as part of a national priority for skin cancer prevention. 

Workplace interviews, a review of literature and existing programs, and expert consultants helped increase dissemination potential by expanding an intervention for occupational skin cancer prevention to include heat illness prevention. Content consultants included safety training professionals, behavioral scientists, and dermatologists. The program, Go Sun Smart at Work, also includes messaging for outdoor workers of all skin types and risk profiles for both heat illness and skin cancer to be delivered online through workplace learning management systems to improve its dissemination. It will be evaluated in 2024 in a randomized controlled trial enrolling 20 worksites, their managers, and outdoor employees. 

A virtual learning environment (VLE) has been programmed to disseminate and guide the implementation of comprehensive sun exposure reduction to workplaces. The VLE is a web-based program with a content database, a media platform for trackable employee training (compliant with eLearning standards), and an innovative, automated decision support tool. The tool is a chat bot-like program that customizes advice on adopting workplace policy and implementing prevention procedures to management’s readiness to innovate on sun safety based on Diffusion of Innovations Theory.  

Solar radiation prevention is urgently needed to help outdoor workers adapt to a warming world. Employers have been adopting virtual training rapidly to improve accessibility, resource and learning efficiency, engagement and information retention, and fidelity and trackability. Improvements in dissemination, training, and practice, as facilitated by this VLE, can save employers time and money, improve employee health behaviors, and reduce solar-related adverse events at work.  

This research was supported by a grant (CA257778; Ms. Mary Buller, PI) from the National Cancer Institute. Coauthors on this poster presentation included Dr. Barbara Walkosz, Ms. Julia Berteletti, Mr. Brandon Herbeck, Ms. Irene Adjei, and Dr. David Buller from Klein Buendel.  

Decreasing access to marijuana by alcohol-impaired customers

Decreasing access to marijuana by alcohol-impaired customers

Recreational marijuana markets appear to be contributing to morbidity and mortality due to polysubstance impaired driving and other harms by selling a social intoxicant (marijuana) to already intoxicated customers. Impairment increases when marijuana is combined with alcohol, making driving particularly risky and also contributing to other injuries and violence. In recreational marijuana markets, deterrence efforts to reduce impaired driving directed at drivers face challenges due to dispute over THC levels in per se laws and lack of valid field sobriety tests.

A team of researchers at Klein Buendel, the Pacific Institute for Research and Evaluation, and NORC at the University of Chicago, is launching a new 5-year research project to study an alternative prevention approach — decrease access to marijuana by alcohol-impaired customers. The goal of this study is to test the effectiveness of a policy and training intervention in the state-licensed recreational marijuana market in a Northwest State, where state law bans sales to apparently-intoxicated customers. It combines policy efforts by state regulators to increase deterrence of the state’s law and motivate store management to comply and training of store personnel in skills to recognize intoxication and refuse sales, using a responsible marijuana vendor online training developed by the research team.

Specific Aims

Aim 1: Conduct pseudo-intoxicated patron (PiP) assessments at state-licensed recreational marijuana stores in the state’s largest metropolitan area in Year 1.

Aim 2: Implement a policy and training (PT) intervention in Year 2 designed to increase compliance with the state law prohibiting sale of recreational marijuana products to apparently-intoxicated customers with a subsample of stores, assigned at random, that intends to: a) make owners/managers of recreational marijuana stores aware of the state’s law prohibiting sales of marijuana to apparently-intoxicated customers, b) increase their risk perception and motivation to comply with this law, and c) train store personnel in skills needed to recognize signs of intoxication in customers and refuse sales.

Aim 3: Compare PT intervention stores to usual and customary policy and training stores in a randomized controlled trial by posttesting state-licensed recreational marijuana stores in the large metro area with PiP assessments for refusal of sales in Year 3.

Aim 4: Estimate impact of the PT intervention on refusal to PiPs by implementing the PT intervention with the remaining stores in Year 3 in a partial cross-over design and assessing state-licensed stores with the PiP protocol in Year 4 and in Year 5.

The research is innovative and high impact by testing one of the first interventions to prevent recreational marijuana sales to apparently-intoxicated customers in one of the first states to ban such sales to reduce the risk of polysubstance impaired driving and other harms. The design allows for reproducibility by using a partial crossover. The PT intervention can be a model intervention to improve compliance with regulations on recreational marijuana sales in other states that have legalized recreational marijuana or that are considering legalization. 

The research is supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA031591). Dr. W. Gill Woodall and Dr. David Buller from Klein Buendel are the Project’s Multiple Principal Investigators. Dr. Robert Saltz from the Pacific Institute for Research and Evaluation and Mr. James Fell from NORC are collaborating Co-Investigators.

KB Investigators Present at EUSPR

KB Investigators Present at EUSPR

Three Klein Buendel Principal Investigators gave presentations on their recent or active research projects at the 14th European Society for Prevention Research Conference held October 4-6, 2023 in Sarajevo, Bosnia and Herzegovina. The presenters were Dr. David Buller, Director of Research, Dr. Barbara Walkosz, Senior Scientist, and Ms. Mary Buller, President. Each presentation complemented the conference theme of “Optimizing Prevention Infrastructures.” The prevention interventions were implemented in workplaces to reach their target populations directly and impactfully.   

Presentation 1

Dr. David Buller

“Formative Research on Professional Development Training to Maintain Responsible Beverage Service Practices”

Improved interventions are needed to reduce the negative consequences of alcohol intoxication. Responsible beverage service (RBS) training has been effective at reducing service to intoxicated customers in some cases. Its efficacy might be improved with an intervention that supports RBS techniques in the years between government-required RBS retraining. We conducted formative research to develop an ongoing professional development component for an online RBS training.

Formative research explored feasibility, acceptability, and content for an ongoing professional development intervention for alcohol servers. Semi-structured interviews were performed with owners/managers of licensed establishments (n=10) and focus groups (n=19) and survey (n=24) with alcohol servers in New Mexico and Washington. A prototype of a professional development component was produced, covering advanced RBS skills, support from experienced servers, professionalism, and basic management training, for delivery through social media. It was evaluated in a usability survey with alcohol servers (n=20) in California, New Mexico, and Washington.

While owners, managers, and alcohol servers were favorable toward RBS in their establishments, they endorsed the need for ongoing support for RBS for servers. Among topics of high interest were sharing tips, methods, and stories from experienced servers, balancing pressure to sell, navigating adult-use marijuana laws, dealing with children, recognizing intoxication, and managing difficult customers. The prototype was comprised of 50 social media posts, including text, infographics, videos, and interactive activity. Servers rated it as highly usable and appropriate for themselves and the establishment. Most servers (70%) were interested in receiving the ongoing information and activities.

Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed establishments. Servers were interested in using such program. The professional development component has the potential to improve an existing RBS intervention.

Collaborators on this presentation included Dr. David Buller and Dr. W. Gill Woodall from Klein Buendel, and Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation in California. This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA029364; W. G. Woodall and D. Buller, MPIs).

Presentation 2

Dr. Barbara Walkosz

“Sun Safety Ink!: Sun Safety Practices of Tattoo Studio Clients”

Melanoma is the second most common cancer among young adults in the United States. Sunburn prevalence and low rates of sun protection are elevated in this group. Thus, efforts are needed to promote skin cancer prevention. An estimated 225 million people worldwide have tattoos with 40% of adults ages 18-29 with at least one tattoo, and at least 30% of American have tattooed skin. Sun Safety Ink! is a skin cancer prevention program targeted to clients of tattoo studios The goal of Sun Safety Ink! is to promote full-body comprehensive sun protection to clients of tattoo studios to compliment standard aftercare instructions that recommend sun protection for new tattoos.

Thirty-seven tattoo studios were enrolled in the Sun Safety Ink! program. At pretest, clients were recruited by tattoo artists to complete an online survey that assessed current self-reported sun protection (sunscreen, lip balm, hats, protective clothing, sunglasses, and shade), number of sunburns, and sunbed tanning frequency in the last year. Respondents were also asked to locate the position of tattoos on their body, using a drawing tool. 

A total of 861 clients completed the online survey. Respondent demographics: age, average 31 yrs.; 67% female, 30% male; 60% white, 27% more than one race, 2% African American, 1% Asian and Native American, 13% Hispanic/Latino. The most prominent tattoo locations included: front left arm, 66%, front right arm, 58%, front upper torso, 52%, and back upper torso, 48%. Sun safety practices, that is, full body sun protection, (on a 5-point scale of “always” to “never”) were reported as: apply sunscreen SPF 15+ on face (aftershave, face lotion, or make-up), 3.31; apply sunscreen SPF 30+ on all exposed skin areas, 3.22; reapply sunscreen, 3.08; apply a lip balm, 3.28; wear any hat, 2.91; wear wide-brimmed hat, 2.21; wear sunglasses, 3.89; stay mostly in the shade, 3.38; and wear protective clothing, 2.91. Respondents also reported the number of sunburns as 1.53 and number of times indoor tanning as 1.11 in the last 12 months.

The pretest results indicate that full-body sun safety practices of tattooed adult can benefit from improvement, particularly wearing of hats and sun protective clothing. Further, knowledge of tattoo locations can direct sun safety recommendations to include protecting not only tattoos on arms and torsos but also non-tattooed skin on those areas of the body. Tattoo studies may be a viable location to delivering effective sun safety interventions to hard-to-reach tattooed, young adults.

Collaborators on this presentation included Dr. Barbara Walkosz, Ms. Mary Buller, and Dr. David Buller from Klein Buendel, and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the Department of Veteran Affairs. This research was supported by a grant (CA206569; B. Walkosz, PI) from the National Cancer Institute.

Presentation 3

Ms. Mary Buller

“Protection from Solar Radiation in the Era of Climate Change: Preventing Heat Illness and Skin Cancer for Outdoor Workers”

The sun’s energy is both a necessity and a threat to humans. Extreme heat linked to climate change and unprotected exposure to ultraviolet radiation (UV) make people who work outdoors vulnerable to life-threatening heat illness and skin cancer. It is estimated that infrared radiation (heat) and UV contributed to over 120,000 deaths from skin cancer in 2020 and over 350,000 deaths from excessive heat in 2019. Efforts to protect workers from heat or UV can work in tandem to help outdoor workers adapt to the warming world.

Workplace interviews, a review of literature, and expert consultants helped expand an existing intervention for U.S. occupational skin cancer prevention to include heat illness prevention, and to be delivered online. Content consultants include safety training professionals, behavioral scientists, and dermatologists. The program, Go Sun Smart at Work (GSSW), will be evaluated in 2024 in a randomized controlled trial enrolling 20 U.S. employers.

GSSW is an innovative virtual learning environment and resource hub promoting comprehensive solar radiation policy, training, and personal protection for outdoor workers. It includes (1) a manager resource hub that guides decision-makers through implementation strategies using a structured conversation agent; (2) an employee sun safety training video that is compliant with eLearning standards and compatible with learning management systems for monitoring; and (3) a trove of resources and downloadable materials addressing heat illness and skin cancer prevention. The structured conversational agent adjusts workplace implementation strategies for management’s readiness to innovate on sun safety based on Diffusion of Innovations Theory.

GSSW will help outdoor workers protect themselves from the serious threats of climate change by providing employers with a convenient, comprehensive solar radiation safety policy and training program. It will support the shift to online training to improve accessibility, fidelity, adherence, and tracking, while saving resources.

Collaborators on this presentation included Ms. Mary Buller, Dr. Barbara Walkosz, Ms. Julia Berteletti, Mr. Brandon Herbeck, Ms. Irene Adjei, and Dr. David Buller from Klein Buendel. This research was supported by a grant (CA257778; M. Buller, PI) from the National Cancer Institute.

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 (CE003635). 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. 

References

  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.gov. Youth topics: violence prevention. Interagency Working Group on Youth Programs. Available at: https://youth.gov/youth-topics/violence-prevention. 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. 

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:

Profiles

  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.

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.

B-SMART: RESULTS OF A WEB APP FOR DWI OFFENDER FAMILIES

B-SMART: RESULTS OF A WEB APP FOR DWI OFFENDER FAMILIES

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.