Browsed by
Category: Publication

Design of a high-resistance inspiratory muscle strength training app

Design of a high-resistance inspiratory muscle strength training app

Dr. Kayla Nuss, Klein Buendel Scientist, and a collaborative research team from Klein Buendel and the University of Colorado Boulder have published a paper on the feasibility and design of a novel smartphone app to deliver blood pressure-lowering high-resistance inspiratory muscle strength training in the journal mHealth.

High-resistance inspiratory muscle strength training (IMST) is a time-efficient form of respiratory exercise shown to lower blood pressure in midlife and older adults (aged ≥50 years) in randomized controlled trials delivered in clinical research settings. The purpose of this study was to design a feasible and acceptable smartphone application (app) for independently delivering IMST for lowering blood pressure.

Two rounds of iterative focus groups comprised of midlife and older women and men with above-normal systolic blood pressure (self-reported ≥120 mmHg) were performed to gain feedback on interest in an IMST smartphone app and design features. Focus group results were analyzed using a Consensual Qualitative Research (CQR) coding and data analysis protocol. Clickable wireframes were developed based on focus group findings. The wireframes were then beta tested for usability and additional feedback from target users was obtained.

Among midlife and older adults, there was considerable interest in app-delivered IMST as a
lifestyle intervention for lowering blood pressure. Potential facilitators and barriers of use for a potential app also were uncovered. Furthermore, the app wireframes were found to be highly usable, indicating that the app is ready for full-scale programming. Detailed research methods, analyses, and results of this research are reported in the mHealth paper. In conclusion, the authors report that they have designed a feasible and acceptable smartphone app for independently delivering blood pressure-lowering IMST in midlife and older adults.

The research is supported by an STTR grant to Klein Buendel from the National Heart, Lung, and Blood Institute (HL167375; Dr. Douglas Seals, Principal Investigator, from the University of Colorado Boulder). The authors are Dr. Kayla Nuss, Amanda Brice, and Steven Fullmer from Klein Buendel; and Elizabeth Jones, CeAnn Udovich, Dr. Kaitlin Freeberg, Narissa McCarty, Dr. Douglas Seals, and Dr. Daniel Craighead from the Department of Integrative Physiology at University of Colorado Boulder.

Analysis of Indoor Tanning Legislation in the United States

Analysis of Indoor Tanning Legislation in the United States

Dr. David Buller, Klein Buendel Director of Research, and a national team of scientists, physicians, and attorneys, have published an article in the American Journal of Public Health that describes the progression, content, and stringency of state legislation regulating indoor tanning in the United States.

Skin cancer is a highly prevalent, potentially deadly, and expensive disease. Indoor tanning is a well-established cause of melanoma and keratinocyte (non-melanoma) carcinomas. In the most recent estimates, nearly 6% of adolescents and 5% of adults indoor tan. Most individuals begin indoor tanning as adolescents or young adults. Stringent state indoor tanning laws that include age bans for minors instead of just parental consent are associated with less indoor tanning.

For this study, trained research assistants used legal mapping methods to collect and code legislative bills on indoor tanning introduced in U.S. states, the District of Columbia, and Puerto Rico. The research aimed to (1) describe the progression of state indoor tanning legislation (enacted or failed); (2) detail the content and stringency of bills with special attention to whether bills banned indoor tanning by minors (individuals aged younger than 18 years (under-18 ban); and (3) explore the potential impact of political party affiliation of state government leadership when bills were proposed.

Between 1992 and 2023, 184 bills were introduced in 49 of 50 states and the District of Columbia (56 laws were enacted, and 126 bills failed). An under-18 ban was enacted in 22 states and the District of Columbia. Analyses calculated composite scores on the stringency of age restrictions and of warnings, operator requirements, and enforcement. The research team evaluated associations of the political party of the legislative sponsor and legislature majority. Specific methods, coding protocols, statistical analyses, results, conclusions, limitations, and public health implications are detailed in the American Journal of Public Health paper.

In many states, it took several years and proposed bills before a law on indoor tanning was enacted. Enacted bills were more stringent than failed bills. Party affiliation of the bill sponsor and legislature majority combined to affect bill passage and age restrictions. Increasing support for stringent regulations on indoor tanning is evident and may motivate other states or the federal government to prohibit minors from using indoor tanning facilities in an effort to improve health and prevent death.

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). Paper authors include Dr. Carolyn Heckman, Ms. Anna Mitarotondo, and Mr. Kevin Schroth from Rutgers University; Mr. Alan Geller from Harvard University; Dr. Jerod Stapleton from the University of Kentucky; Ms. Samantha Guild from the AIM at Melanoma Foundation in Texas; Dr. Jeffrey Gershenwald from the MD Andersen Cancer Center at the University of Texas; Dr. Robert Dellavalle from the University of Minnesota; Dr. Sherry Pagoto from the University of Connecticut; and Dr. David Buller, Ms. Julia Berteletti and Ms. Irene Adjei from Klein Buendel.

Recruitment Challenges for Project SHINE

Recruitment Challenges for Project SHINE

Dr. David Buller, Klein Buendel Director of Research, is part of a multiple institution research team that published a paper on recruitment challenges for Project SHINE. The research team is led by Dr. Yelena Wu from the University of Utah and the Huntsman Cancer Institute. The paper entitled, “Challenges and lessons learned in recruiting participants for school-based disease prevention programs during COVID-19,” was published in Contemporary Clinical Trials.

Schools provide an ideal setting for delivery of disease prevention programs due to the ability to deliver health education and counseling, including health behavior interventions, to large numbers of students. However, the remote and hybrid learning models that arose during the COVID-19 pandemic created obstacles to these efforts. The Contemporary Clinical Trials paper provides insights on collaborating with schools to deliver disease prevention programming during the height of the COVID-19 pandemic, and in subsequent years. The authors illustrate recruitment and engagement strategies by drawing upon their research experiences engaging high schools in a school-based cancer prevention trial focused on sun safety.

Delivery of a cluster-randomized trial of a school-based skin cancer prevention program was initiated in the spring of 2020 at the onset of the COVID-19 pandemic in the United States. The authors present multilevel evaluation data on strategies used to reach schools remotely and share lessons learned that may inform similar approaches moving forward during times of crises.

Although the COVID-19 pandemic interrupted school-based recruitment for this trial, enrollment improved one year later and did not appear to differ between rural and urban schools. Recruitment strategies and trial-related procedures were modified to address new challenges brought about by the pandemic. Despite the COVID-19 crisis altering classrooms, disease prevention programming can continue to be offered within schools, given close community partnerships and new adaptations to the ways in which such programming and research are conducted.

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 from Klein Buendel is a Co-Investigator.

Smartphone Web App for DWI Offenders and Families

Smartphone Web App for DWI Offenders and Families

Driving while intoxicated (DWI) results in significant morbidity and mortality. The use of vehicle ignition interlock devices decreases the risk of drinking and driving while installed, but DWI rates increase after the devices are removed. Dr. W. Gill Woodall, Klein Buendel Senior Scientist, and his research collaborators have developed and tested the B-SMART smartphone web app to continue to support offenders and their concerned family members after their ignition interlock devices have been removed. They have published their methods and results of usability testing online in the Journal of Substance Use and Addiction Treatment.

Formative data collection for app development occurred in two phases. Phase 1 included key informant interviews with DWI offenders and concerned family members, development of one app module, and usability testing. Phase 2 included focus groups with DWI offenders and concerned family members, development of three more app modules, and usability testing. The Bangor System Usability Scale was used to rate app usability and satisfaction.

Results of key informant interviews and focus groups indicated that offenders and family members lacked information and were frustrated by the ignition interlock device, experienced financial burden from the DWI and the device, viewed supportive communication and positive shared activities as important, and were positive about the app. The four modules developed were Life with Interlock, Supporting Changes in Drinking, Doing Things Together, and Effective Communication. Each module included an introduction, at least one interactive activity, a video, and text to summarize what was presented. The content of the app modules was written primarily for the concerned family members. Usability testing indicated that the B-SMART modules were easy to use and informative.

The paper published online in the Journal of Substance Use and Addiction Treatment details the research measures, methods, analyses. A diagram describes the flow for the features and design of the app. This careful formative work resulted in an app responsive to the concerns of DWI offenders with ignition interlock devices and their concerned family members.

The authors believe that harnessing the power of the family to help the offender maintain a pattern of driving when not impaired may yield longer, successful outcomes initiated by the ignition interlock device. A future paper will report the efficacy of the B-SMART app after its implementation and testing in a rigorous randomized trial.

This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA022850; Dr. W. Gill Woodall, Principal Investigator). Collaborators included Dr. Barbara McCrady, Dr. Randall Starling, and Dr. Vern Westerberg from the University of New Mexico; Mr. Thomas Starke from Impact DWI in Sante Fe, New Mexico; and Ms. Julia Berteletti, Ms. Marita Brooks, and Ms. Lila Martinez from Klein Buendel. The B-SMART app was developed by the Creative Team at Klein Buendel.

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.