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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.

IMST for Reducing High Blood Pressure

IMST for Reducing High Blood Pressure

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

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

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

Specific Aims

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

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

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

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

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

Changes in patients’ family communication after offer of skin cancer genetic test

Changes in patients’ family communication after offer of skin cancer genetic test

Melanoma is a serious preventable form of skin cancer. Genetic testing for skin cancer risk may help increase awareness. A team led by Dr. Jennifer Hay from the Memorial Sloan Kettering Cancer Center, and including Dr David Buller from Klein Buendel, examined how an offer for testing for the melanocortin-1 receptor gene (MC1R) may have enhanced communication surrounding skin cancer within families. The research team presented a poster of their findings at the 44th Annual Sessions and Meeting of the Society of Behavioral Medicine in Phoenix, Arizona on April 26-29, 2023.

The study examined frequency targets (which family member) and topics of family communication around skin cancer at a 3-month follow-up within a New Mexico study that randomized primary care patients (N=600; 48% Hispanic) to MC1R test invitation or usual care (Aim 1). Frequency and targets were assessed on 4-point scales (“not at all” to “a lot”) asking participants how often they talked with family and with each target. Topics were assessed by asking participants whether they discussed a series of topics with family. The impact of usual care genetic test refusal and test results (average or higher risk feedback) on frequency targets and topics of family communication was assessed using ANOVAs and Chi-Square tests (Aim 2).

Aim 1 analysis showed that at the 3-month follow-up the average frequency of overall family communication was between “a little” and “some”. The most common communication targets were spouses and children; the most common topic was sun protection. Aim 2 analysis showed no significant differences in communication frequency. However, communication targets who received high-risk feedback reported greater communication with their spouse compared to those in usual care. Lastly, the study found that certain topics of communication such as “who had skin cancer in the family” and “your own risk of getting skin cancer” were discussed more by those who had testing (both receiving average and high-risk feedback) than by those in usual care or by test refusers.

The findings provide important insight into family communication about skin cancer. The results indicate greater discussion with certain people and about certain topics when individuals had undergone genetic testing highlighting the potential role that genetic testing can play in fostering family communication. Future research could provide deeper insight into why individuals talk to certain people and about certain topics more than others as well as examine how family communication affects decision-making regarding offers for cascade genetic testing or interpretation of results.

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

Physical Activity Research with Apps and Wearable Trackers

Physical Activity Research with Apps and Wearable Trackers

Klein Buendel Scientist, Dr. Kayla Nuss, was a presenter or co-author on four panels, posters, and presentations at the 44th Annual Sessions and Meeting of the Society of Behavioral Medicine in Phoenix, Arizona on April 26-29, 2023. The presentations highlighted research Dr. Nuss conducted as a Post-doctoral Fellow at the University of Victoria in Canada before joining Klein Buendel as a Scientist in 2022.

Dr. Kayla Nuss at SBM

Presentation 1: Poster Session

“Examining the Effect of Daily Social Media Use of Physical Activity Behaviors: A Daily Diary Study”

Presenters: Ms. Rebecca Coulter, Dr. Sam Liu, and Dr. Kayla Nuss

Previous studies have assessed the effects of health-related social media use on physical activity; however the evidence remains mixed. Currently, little is known about how daily social media use influences daily physical activity behavior. Understanding the influence of social media use on physical activity behavior may help design future interventions. The objective of this study was to examine whether the daily consumption of health-related social media content is associated with daily physical activity behaviors. Results provided evidence that viewing health-related social media content can influence daily physical activity behavior – specifically , exercise intensity. The authors suggested that future studies should focus on within-person variations in behavior based on social media use.

Presentation 2: Symposium 1

“Contextual and Situational Motivation for Physical Activity in Wearable Activity Tracker Users: A Daily Diary Study”

Presenters: Ms. Rebecca Coulter, Dr. Sam Liu, and Dr. Kayla Nuss

Wearable activity trackers (WAT) were developed to support physical activity engagement but little is known about how WAT users are motivated for physical activity. The presenters have identified distinct motivational profiles among WAT users; but no study has assessed the relationship between contextual and situational motivation for physical activity. To evaluate this relationship, intensive daily survey methodology is needed. Understanding the relationship between contextual and situational motivation for physical activity is critical to improve the effectiveness of WAT. The objectives of the study were to: (1) evaluate the feasibility of collecting day-level situational motivation for physical activity using a customized mobile app made by a no-code app development platform; and 2) describe two levels of motivation (contextual and situational) in WAT users using the hierarchical model of motivation. The presenters hypothesized that they would identify distinct motivational profiles and that those profiles would predict differing levels of situational motivation. Collecting situational motivation for physical activity was feasible using a no-code mobile platform. WAT users vary in their contextual motivational profile for physical activity and these predict some types of situational motivation. They suggested that future research should further investigate physical activity motivation in WAT users to identify intervention opportunities. 

Presentation 3: Symposium 2

“Implementing Mobile Health Interventions and Observational Studies Using a No-code App Development Platform”

Presenters: Dr. Denver Brown, Dr. Sam Liu, Dr. Kayla Nuss, and Ms. Amanda Willms

Mobile health (mHealth) technology holds tremendous potential to deliver behavior health interventions and understand human behavior. However, a challenge facing researchers when conducting mHealth research is the resources required to develop and maintain mHealth apps. Specifically, a no-code mHealth research app development platform may enable researchers with no previous software programming skills to create apps through a graphical user interface. In this symposium, presenters discussed how a no-code app development platform, was created and used to co-design and implement physical activity mHealth interventions and conduct longitudinal observational studies to understand physical activity behavior. The first presenter provided an overview of the no-code mHealth research platform and discussed its development and usability testing. The second presenter discussed how the platform was used to co-design adaptive mHealth physical activity interventions. Dr. Nuss discussed how the platform was used to implement a daily diary study to examine changes in situational motivation for physical activity based on contextual motivational profile in current wearable activity tracker users over a 14-day period. The final presenter discussed how the platform was used conduct a longitudinal feasibility study examining the influence that first-year roommates have on one another’s device-measured physical activity behavior during the transition to university which included weekly surveys to capture dyadic relations.

Presentation 4: Paper Session

“Reflecting on Physical Activity across Two Years of the COVID-19 Pandemic: Predictors if Intention-Behavior Profiles”

Presenter: Dr. Ryan Rhodes

Co-authors: Dr. Sam Liu, Dr. Kayla Nuss, and Dr. Wuyou Sui

The COVD-19 Pandemic has affected how many people engage in regular moderate-to-vigorous intensity physical activity (MVPA). Understanding the correlates of various motivational and behavioral profiles is important to producing effective interventions. The purpose of this study was to predict current and dynamic (across two years of the COVID-19 Pandemic) intention and MVPA profiles using the multi-process action control (M-PAC) framework. Few participants increased MVPA across the pandemic and dynamic patterns of intention-MVPA profiles by pre-pandemic MVPA showed the presence of two at risk groups (relapsed non-intenders relapsed unsuccessful intenders) who have relapsed in MVPA. Collectively, the findings support the joint promotion of reflective regulatory and reflexive processes in the choice of behavior change techniques to promote post-pandemic MVPA intention and behavior. 

Stringency of State Indoor Tanning Laws

Stringency of State Indoor Tanning Laws

Approximately five million cases of skin cancer are diagnosed among Americans at a cost nearing $9 billion annually. Indoor tanning (IT) is a risk factor for skin cancer. Restricting IT facilities, especially access by minors, has been the subject of state laws. More stringent restrictions on youth access (for example, bans by age vs. parental consent laws) appear to be associated with reduced IT by youth.

Julia Berteletti and David Buller at SBM

A team led by Dr. Carolyn Heckman from Rutgers University and Dr. David Buller from Klein presented a poster characterizing the IT policy landscape of U.S. states at the 44th Annual Sessions and Meeting of the Society of Behavioral Medicine in Phoenix, Arizona on April 26-29, 2023. The poster was entitled “Comparison of the stringency of indoor tanning bills regarding minors that passed and failed in state legislatures over the last 30 years.”

The research team coded 107 state IT law documents and compared passed laws to failed bills (proposed but not voted on or proposed but voted down), using a validated coding tool that assessed the presence of age bans, parental consent/accompaniment, warnings, operator requirements, and enforcement. Component codes were scaled on 10-point stringency measures (0=no regulation, 10=very strong regulation). Component and total summed scores were calculated, with higher scores indicating more stringent IT restrictions.

Between 1991 and 2022, 46 states and the District of Columbia passed a law on IT, with 23 banning access to IT facilities by minors under age 18. By contrast, 60 bills on IT failed to pass in 31 states since 2008. However, stringency of laws is weak, overall, which may explain why recent research found low compliance of IT facilities with regulations and continued IT among minors. Failed bills without minor bans were less stringent than similar passed laws, on nearly all components. Failure may have presented advocates opportunities to improve stringency of subsequent bills and time to garner more support for IT restrictions. In fact, less stringent bills may have failed because they had less support from outside constituencies (for example, medical societies and public health advocates) and among legislators. To gain insight into this public health legislation process, we are interviewing key informants from states with recent policy activity.

This research was supported by a grant to Rutgers University from the National Cancer Institute (CA244370; Dr. Carolyn Heckman and Dr. David Buller, Multiple Principal Investigators). Co-authors included Ms. Julia Berteletti from Klein Buendel and Ms. Anna Mitarotondo from Rutgers University.

Usability Testing of Just Care Modules in Prisons

Usability Testing of Just Care Modules in Prisons

Prison population demographics are shifting such that many people will grow old and spend their final days in prison. Research evidence supports using peer caregivers to assist prison staff with providing supportive care. However, the training received by peer caregivers varies widely. Evidenced-based, accessible, and contextually relevant learning materials are needed to effectively prepare peer caregivers for their role.

A research team from The Penn State University Ross and Carol Nese College of Nursing and Klein Buendel have developed Just Care, a six-module e-learning program designed to augment the face-to-face training that is typically provided to peer caregivers. Small-scale usability testing of the Just Care program was conducted with twenty men and women, who are incarcerated, and ten staff members at one men’s and one women’s state prison in a southeastern state. Two rounds of usability tests were conducted via a video-conferencing platform. The results of the usability tests were recently presented at the annual conference of Academic Consortium on Criminal Justice Health (ACCJH) in Raleigh, North Carolina on April 13-14, 2023.

Most users, who were incarcerated, did activities without aid and no tasks or programming issues were identified that made it impossible to use the application as intended. However, a few usability and content issues were noted including: (a) some users did find the x-ray scanner activity challenging when trying to drag the scanner across the body image to reveal symptoms as death approaches; and (b) a few staff users noted that the returning citizens’ video testimonials in the Staff Module lacked racial diversity.​

The System Usability (SUS) scores for each round respectively were 87.5 (incarcerated), 74.5 (staff); and 85.28 (incarcerated), 83.75 (staff). A SUS score of 68 is considered above average. Overall, both participant groups found Just Care easy to navigate with content that is interactive, useful, engaging, and relevant. Prison staff noted that Just Care raised awareness about peer caregivers’ need for training to help care for older people in prisons.

Next steps for the research team is to address the issues raised in the usability tests and prepare for large-scale usability testing to be conducted in state prisons in the summer and fall of 2023. 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 ACCJH poster presentation also included Dr. Erin Kitt-Lewis, Mr. Sherif Olanrewaju, and Ms. Katherine Aiken from The Penn State University; and Ms. Amanda Brice and Mr. Steve Fullmer from Klein Buendel.