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Implementation of an Occupational Sun Safety Intervention: Comparison of Two Scalability Strategies

Implementation of an Occupational Sun Safety Intervention: Comparison of Two Scalability Strategies

Klein Buendel investigators and their collaborators have published the results of the Go Sun Smart at Work project in the Journal of Occupational and Environmental Medicine. This research compared two methods for scaling up an evidence-based occupational sun protection program nationwide. One hundred thirty-eight (138) regional districts in 21 state Departments of Transportation throughout the United States were randomized to receive the Go Sun Smart at Work program via in-person or digital scalability methods in 2019-2022 in 1:2 ratio. Managers completed pretest and posttest surveys and employees completed posttest surveys. Due to the COVID-19 pandemic, only posttest measures were analyzed (from 255 managers and 1387 employees).

After scale-up, more employees reported training and communication at workplaces in in-person rather than digital strategy. There were no differences in managers’ reports of sun protection training, communication, or actions by scalability method. Overall, occupational sun protection was implemented during program scale-up and employees recalled training/communication more in the in-person than digital strategy. A full description of methods, analyses, and results can be found in the Journal of Occupational and Environmental Medicine publication.

The research was supported by a Cancer Moonshot Initiative grant from the National Cancer Institute (CA210259; Dr. David Buller, Principal Investigator). Collaborators include Dr. Richard Meenan from Kaiser Permanente Center for Health Research, Dr. Gary Cutter from the University of Alabama in Birmingham, Dr. Kimberly Henry from Colorado State University, and Ms. Mary Buller, Ms. Julia Berteletti, Ms. Alishia Kinsey, Ms. Irene Adjei, and Mr. Noah Chirico from Klein Buendel. The authors thank the American Association of State Highway and Transportation Officials (AASHTO) and the senior managers of the participating state Departments of Transportation for supporting this project.

E-learning modules for peer end-of-life caregivers living in prison

E-learning modules for peer end-of-life caregivers living in prison

A research team led by Dr. Susan Loeb from Penn State University and Dr. Barbara Walkosz from Klein Buendel, has published results from a recent study in the Journal of Offender Rehabilitation. The paper reports findings from the usability testing of the Just Care electronic learning program for training carefully vetted people living in prison to assist staff with geriatric and end-of-life care. 

Aging is accompanied by an increased probability of health problems and subsequent need for health care. According to the authors, “The growing number of older adults living in prison, who will likely age and die in prison, calls attention to the challenge of how correctional facilities will care for this population’s health needs, which includes the increasing demand for geriatric and end-of-life care.” Training men and women who live in prison to assist corrections staff with the care of growing numbers of older, sicker, cognitively impaired, and dying people in prison is an innovative and viable option to help meet pressing care demands. 

Two rounds of usability testing were conducted via videoconference. Prison personnel (such as corrections specialists, supervisors, nurses, and chaplains) and people living in prison were recruited from one men’s prison and one women’s prison. Fifteen participants completed the testing in each of two rounds. Methods and analyses are described in the paper.

Results include participant demographics, concerns and areas for improvement by severity level of programming, and mean scores for both participant groups on the System Usability Scale.  Overall, both the incarcerated and staff participants found the program easy to navigate and the interactive content was useful, engaging, and relevant to caring for incarcerated aging and dying people. The findings helped refine Just Care before additional evaluation was conducted with a larger sample.

This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging (AG057239; Dr. Susan Loeb and Dr. Barbara Walkosz, Multiple Principal Investigators). The lead author on this Journal of Offender Rehabilitation paper is Dr. Erin Kitt-Lewis from Penn State University. Additional authors are Dr. Susan Loeb and Mr. Sherif Olanrewaju from Penn State University; and Dr. Barbara Walkosz, Mr. Brandon Herbeck, and Mr. Steve Fullmer from Klein Buendel. 

Sales of Alcohol to Apparently Intoxicated Customers in Three States

Sales of Alcohol to Apparently Intoxicated Customers in Three States

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

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

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

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

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

This research was supported by a grant to Klein Buendel from the National Institute on Alcohol Abuse and Alcoholism (AA029364; W. Gill Woodall and David Buller, Multiple Principal Investigators). Collaborating authors include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in Berkley, California, Dr. Gary Cutter from the University of Alabama, and Ms. Lila Martinez, Ms. Annelise Small, and Mr. Noah Chirico from Klein Buendel.

Cancer Fatalism and Engagement with Skin Cancer Genetic Information

Cancer Fatalism and Engagement with Skin Cancer Genetic Information

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

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

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

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

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

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

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.

#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.  

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.