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Evaluation of the STAC
Teacher Module

Evaluation of the STAC
Teacher Module

Bullying is a significant problem for youth and is associated with a wide range of negative consequences. Educating teachers about bullying and training them to support students to intervene as “defenders” may increase the efficacy of bullying bystander programs. This is particularly important in middle school when bullying peaks and rates of reporting bullying to teachers begin to decline.

This study, published in JMIR Formative Research, used a mixed-methods design to inform the development of a Teacher Module as a companion training to a brief bullying prevention program for middle schools, called STAC. The STAC bystander intervention is a 75-minute training that includes didactic and experiential components. It teaches middle school students to act as “defenders” on behalf of targets of bullying through utilizing four intervention strategies:

STAC Bullying Bystander Strategies

(1) “Stealing the Show” – using humor or distraction to interrupt a bullying situation and remove the attention away from the target;

(2) “Turning it Over” – identifying a trusted adult at school, reporting, and asking for help during a bullying incident;

(3) “Accompanying Others” – befriending and/or providing support to a peer who was a target of bullying; and

(4) “Coaching Compassion” – gently confronting the perpetrator and increasing empathy for the target.

Providing students who witness bullying with intervention strategies to act as “defenders” can reduce both bullying and negative associated outcomes for both targets and bystanders.

For the development of the companion STAC Teacher Module, 18 teachers were recruited from one middle school in a rural, low-income community. Before and after the training, teachers completed surveys assessing immediate outcomes (such as knowledge, confidence, comfort, and self-efficacy), intention to use the program strategies, and program acceptability and relevance. After the final survey, a subset of six teachers participated in a qualitative focus group to obtain feedback regarding program appropriateness, feasibility, content, perception of need, and potential desire for an online version of the teacher training.

Study measures, procedures, analyses, and results are detailed in the JMIR Formative Research paper. Descriptive statistics, independent sample t-tests, and thematic analysis were used to analyze the data. In summary, the researchers found an increase in teacher knowledge and confidence to support “defenders,” confidence and comfort in managing bullying, and bullying self-efficacy. Most teachers reported they were likely or very likely to use the STAC strategies to support students who intervene in bullying in the future. Both quantitative and qualitative data showed the teacher training was easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on program improvement. Teachers shared positive feedback on program feasibility and implementation, and described strengths of an online version of the module. This study demonstrates the effectiveness of the STAC Teacher Module in increasing teacher knowledge and bullying self-efficacy and provides support for the development of an online version of the module for teachers.

This research was supported by a grant to Boise State University from the Mental Research Institute (Dr. Aida Midgett, Principal Investigator). Co-authors include Dr. Diana Doumas from Boise State University and Ms. Mary Buller from Klein Buendel.

EZPreemie Study Protocol

EZPreemie Study Protocol

A research team from The Ohio State University, Rush University, Nationwide Children’s Hospital, and Klein Buendel has published a paper describing a 5-year research project to develop and evaluate a technology-based, widely accessible, and effective form of behavioral parent training (BPT) delivery to address the unmet and unique needs of parents of very preterm children.

As presented in the paper published in BMJ Open, children born very preterm (gestational age <32 weeks) are twice as likely to demonstrate behavior problems such as aggression, non-compliance, temper tantrums and irritability compared with their term-born peers. While BPT is a gold standard for prevention and treatment of childhood problem behaviors, there are limited accessible and effective BPT interventions for families with children born very preterm. The paper describes a multi-center, randomized controlled protocol for a factorial design trial evaluating the independent and combined effects of the ezParent BPT intervention plus brief, weekly coaching calls on parent and child outcomes for families with toddlers born very preterm.

The BMJ Open paper details the study design, aims, intervention, measures, analysis plans, and procedures of the study which will employ a 2×2 factorial randomized design. Parents (n=220) of children aged 20–30 months corrected age who were born very preterm (<32 weeks) will be recruited from two large metropolitan Neonatal Intensive Care Unit follow-up clinics and randomized to one of four conditions: (1) ezParent (2) ezParent + coach, (3) active control or (4) active control + coach. A web-based app will provide behavioral training through brief videos, interactivity, reflection questions, and assessments. Data on parenting and child behavior outcomes will be obtained from all participants at baseline and 3, 6 and 12 months for program evaluation.

This research is being led by Dr. Susan Breitenstein from The Ohio State University (OSU) and Dr. Michelle Greene of Rush University (Multiple Principal Investigators). It is funded by a grant from The Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institute of Health (HD104072). Additional co-authors on this publication include Dr. Michael Schoeny and Dr. Kousiki Patra from Rush University; Dr. Sarah Keim from Nationwide Children’s Hospital and OSU; Dr. Mary Lauren Neel from Nationwide Children’s Hospital; Ms. Shea Smoske from OSU; and Ms. Julia Berteletti from Klein Buendel.

Evaluation of the ECAD-P Program for Prison Staff

Evaluation of the ECAD-P Program for Prison Staff

There are nearly 2.3 million people incarcerated in U.S. prisons. Many grow old there and need end-of-life care. Geriatric and end-of-life care in Corrections is not as equitable as care in the free world. The results of a study led by researchers from Penn State University and Klein Buendel were published recently in the International Journal of Prisoner Health. The research team developed and evaluated the technological delivery of geriatric training for prison staff as a novel approach to improve care and reduce disparities among those who are most vulnerable during confinement.

Evaluation of the ECAD-P computer-based learning program occurred at seven sites, including six state prisons and one prison healthcare vendor. A total of 241 staff were recruited and 173 completed posttesting. The outcomes were (a) knowledge acquisition regarding care for aging and dying incarcerated persons, and (b) attitudes, motivations and values for providing geriatric and end-of-life care. Staff improved their knowledge and affective indicators after receiving the training. ECAD-P was determined to be acceptable, feasible, and usable in Corrections.

Correctional settings face increasing pressures to better address the healthcare and management needs of aged, chronically ill, and dying incarcerated persons. ECAD-P may contribute to better preparation of Corrections staff to effectively care for these populations.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). The authors of this publication are Dr. Valerie Myers, formerly of Klein Buendel; Dr. Susan Loeb and Dr. Erin Kitt-Lewis from the Ross and Carol Nese College of Nursing at The Pennsylvania State University; and Tiffany Jerrod, formerly of Klein Buendel.

Risks and Protective Factors for Non-medical Prescription Drug Use among Teen Girls

Risks and Protective Factors for Non-medical Prescription Drug Use among Teen Girls

Prevention efforts can be informed by learning more about the risks and protective factors for adolescent non-medical use of prescription drugs (NMUPD). A study was conducted with data collected from the Health Chat study to look at the potential influence of maternal factors, social norms, and perceptions of risk and availability on NMUPD by adolescent females. Health Chat was a social media intervention to help reduce mothers’ permissiveness toward their teen daughters’ indoor tanning behavior in an effort to prevent skin cancer. Mother-daughter communication on other health topics was also analyzed. Methods and findings for this NMUPD analysis have been published online in the journal, Drugs: Education, Prevention and Policy.

Multiple logistic regression was used for analysis. Daughters’ past NMUPD and inclination for future NMUPD were regressed onto descriptive norms for friend use, perceived drug accessibility and risk of harm from use, daughter age, mothers’ disapproval about use, mothers’ past NMUPD and inclination for future NMUPD, and the mother-daughter relationship quality. Akaike weights and lasso regressions were also estimated to evaluate the relative importance of each correlate. Higher descriptive norms for friend use, older age, and mothers’ inclination for NMUPD were risk factors for daughters’ NMUPD. Protective factors were a closer mother-daughter relationship and mothers’ disapproving attitudes towards NMUPD. The authors conclude that friend descriptive norms, mother-daughter relationship quality, and mothers’ attitudes about NMUPD could be explored as key targets for prevention efforts.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). The lead author is Gemma Wallace from Colorado State University. Collaborating authors include Dr. Katie Baker and Dr. Stephanie Mathis from East Tennessee State University; Dr. Kimberly Henry from Colorado State University; Dr. Sherry Pagoto from the University of Connecticut; and Dr. David Buller and Julia Berteletti from Klein Buendel. 

Persisting Effects of the Health Chat Program

Persisting Effects of the Health Chat Program

The use of indoor tanning facilities by minors is a public health concern. In an effort to reduce risk for skin cancer, the Health Chat social media intervention was launched by Klein Buendel researchers and their colleagues to reduce mothers’ permissiveness toward their teenage daughters’ indoor tanning behavior.

For the Health Chat study, mothers with daughters aged 14-17 were recruited in 34 states that do not ban indoor tanning by minors. Participating mothers received an adolescent health social media campaign in Facebook private groups. Half of the mothers were in a group in which the health campaign included posts about preventing indoor tanning (intervention) and the other half, included posts on preventing prescription drug misuse (control). Follow-up surveys with mothers at 12 months and 18 months measured indoor tanning permissiveness, attitudes, intentions, communication, behavior, and support for state indoor tanning bans.

Analysis of the 18-month follow-up data from the Health Chat social media intervention was e-published recently in Cancer Epidemiology, Biomarkers & Prevention. The research was led by Dr. David Buller from Klein Buendel and Dr. Sherry Pagoto from the University of Connecticut.

The methods and results of this randomized trial are detailed in the publication. Data analysis showed that at 18 months after the intervention, mothers in the intervention group were less permissive of indoor tanning by daughters and had greater self-efficacy to refuse daughter’s indoor tanning requests than mothers in the control group. Intervention-group mothers also had lower intentions to indoor tan themselves and were more supportive of bans on indoor tanning by minors than control-group mothers. In addition, daughters in the intervention group expressed less positive attitudes toward indoor tanning than daughters in the control group.

In summary, the Health Chat social media intervention may have influenced mothers’ decisions to withhold permission for their daughters to indoor tan for six months after the end of the program. Mothers’ support for bans on indoor tanning by minors also appears to have persisted.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kimberly Henry from Colorado State University; Jessica Bibeau from the University of Connecticut; and Dr. Barbara Walkosz, Julia Berteletti and Alishia Kinsey from Klein Buendel. 

Family Attitudes and Communication about Sun Protection

Family Attitudes and Communication about Sun Protection

Young melanoma survivors and their families are at increased risk for developing melanoma, yet do not often practice sun protection for skin cancer prevention. Currently, little is known about the role of family interaction in sun protection.

Klein Buendel Senior Scientist, Dr. David Buller, was one of several authors on a recent paper on family attitudes and communication about sun protection among young melanoma skin cancer survivors and their family members e-published in the Journal of Health Communication. The research team was led by Dr. Sharon Manne from the Department of Medicine, Behavioral Sciences Section at the Rutgers Cancer Institute of New Jersey.

The research team set out to “examine correspondence between survivors and family sun protection, individual attitudes, and family attitudes and communication about risk-reducing behaviors, and evaluate the mediating role of family attitudes and communication in the association between individual sun protection attitudes and behavior.” Participants completed questionnaires about their individual attitudes, family attitudes and communication, and sun protection behaviors.  

Analyses showed that families had varying levels of shared attitudes and behaviors. Family discussion was associated with higher sun protection for both men and women. Other findings differed for men vs. women and cancer survivors vs. family members. Full descriptions of the measures, methods, results, and conclusions can be found in the publication. Overall, the authors believe that family-focused interventions may prove effective because families’ attitudes and practices correspond with each other.

This research was supported by a grant from the National Institutes of Health (Dr. Sharon Manne, Principal Investigator). Other authors on the publication include Dr. Deborah Kashy from Michigan State University; Dr. Sherry Pagoto from the University of Connecticut; Dr. Susan Peterson from the University of Texas MD Anderson Cancer Center; Dr. Carolyn Heckman, Joseph Gallo, Dr. Adam Berger, Alexandria Kulik, Sara Frederick, and Morgan Pesanelli from the Rutgers Cancer Institute of New Jersey; and Dr. David Buller from Klein Buendel.

Mutual Influences of Mothers’ and Daughters’ Mental Health on the Closeness of their Relationship

Mutual Influences of Mothers’ and Daughters’ Mental Health on the Closeness of their Relationship

A Health Chat study published in the Journal of Child and Family Studies examined intra- and interpersonal associations between poor mental health and mother–daughter relationship closeness in a sample of 467 dyads. Health Chat was a social media intervention designed to reduce mothers’ permissiveness toward their teen daughters’ indoor tanning behavior. It also addressed other adolescent health topics, such as vaccination, alcohol, and physical activity.

An Actor–Partner Interdependence Model was used to examine bidirectional processes between mothers and their teenage daughters. The independent variable was self-reported poor mental health and the dependent variable was relationship closeness. Communication satisfaction was also examined as a potential interpersonal mediator of the pathway between poor mental health and relationship closeness.

Daughters’ self-reported poor mental health negatively predicted their own perception of closeness as well as mothers’ perception of closeness. In addition, there was evidence that perceived communication may help explain both the actor effect (one’s own poor mental health on one’s own perception of closeness) and the partner effect (partner’s poor mental health on one’s own perception of closeness).

Detailed methods and results are presented in the publication. Results suggest that when daughters’ mental health is poor, relationship closeness as perceived by mother and daughter may be weakened, and that this effect may in part be explained by poor communication between mother and daughter. The authors concluded that strategies to promote family communication, especially for families experiencing mental health problems, may aid in the development of closer mother–daughter relationships.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; David Buller and Sherry Pagoto, Multiple Principal Investigators). Additional collaborating authors include Hyanghee Lee (lead author) and Kimberly Henry from Colorado State University; Katie Baker and Joel Hillhouse from East Tennessee State University; Jessica Bibeau from the University of Connecticut; and Barbara Walkosz and Julia Berteletti from Klein Buendel. 

Let’s Talk About Skin Cancer

Let’s Talk About Skin Cancer

Family communication about skin cancer risk may motivate people to put sun protection into practice. However, the availability, distribution, and reach of such communication is not well known.

In a recent publication in the Journal of Health Communication, authors including Dr. David Buller from Klein Buendel, describe prevalence and patterns of family communication about skin cancer across 600 diverse primary care patients. The patients were from Albuquerque, New Mexico, a geographical location with low latitude and significant year-round ultraviolet radiation from the sun.

Over half of the patients reported discussing general cancer and skin cancer risks with their families. The most frequent target of skin cancer risk communication included doctors, followed by friends/coworkers, spouse/partner, other family members, sisters, mothers, daughters, sons, fathers, and brothers. On average, participants reported having talked to three family members about skin cancer risks.

The most frequently discussed skin cancer risk communication topics were the use of sun protection, followed by the personal risk of skin cancer, who had skin cancer in the family, family risk of skin cancer, time of sun exposure, and skin cancer screening. Overall, greater family communication about general cancer and skin cancer risks was associated with a family or personal history of cancer, higher perceived risk, higher health literacy, being non-Hispanic, having higher education or income, and proactive sun protective behavior.

These study findings have implications for developing interventions that encourage family discussions about skin cancer risk, sun protection, and skin cancer screening that may foster the adoption of sun-protective behaviors and reduced exposure to harmful ultraviolet radiation.

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. Smita Banerjee (lead author) and Ms. Elizabeth Schofield from the Memorial Sloan Kettering Cancer Center; Dr. Andrew Sussman, Dr. Dolores Guest, Dr. Yvonne Dailey, Dr. Matthew Schwartz, 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.

STAC-T: Formative Research Results

STAC-T: Formative Research Results

Formative research, such as target population focus groups and usability testing, is essential for the design and development of interactive technology-based programs. Usability testing results of a brief web-based middle school bystander bullying prevention program, STAC-T, were published recently in JMIR Formative Research. The research team was led by Dr. Aida Midgett from Boise State University. Key collaborators included Dr. Diana Doumas from Boise State University and Dr. Valerie Myers, formerly from Klein Buendel.

STAC-T translates four strategies to train bystanders to effectively intervene to reduce bullying into a time- and cost-effective web-based program for middle school students and staff. The four strategies are: “Stealing the show,” “Turning it over,” “Accompanying others,” and “Coaching compassion.”

The main purpose of the formative research was to assess the usability and acceptability of a STAC-T prototype in advance of full-scale development. Other aims included understanding school needs and barriers to program implementation, and assessing differences in usability between middle school staff and students. 

Sixteen participants from three middle schools in rural, low-income communities completed STAC-T usability testing and a qualitative interview. The publication describes the usability testing methods and outcomes of data analyses, including ratings of prototype program satisfaction, acceptability, feasibility, needs, barriers, and recommendations for program adjustments. Overall, school staff and students reported satisfaction with the web-based program. They found it easy to use, acceptable, and feasible. The findings have encouraged the authors to pursue the full-scale development of the STAC-T web-based bullying prevention app for middle schools.

The STAC-T feasibility project was funded by a small business STTR grant to Klein Buendel from the National Institute on Minority Health and Health Disparities at the National Institutes of Health (MD014943; Dr. Aida Midgett, Principal Investigator). The STAC-T prototype was programmed by Klein Buendel’s Creative Team.

Mothers and Teenage Daughters: HPV Vaccination Information via Social Media

Mothers and Teenage Daughters: HPV Vaccination Information via Social Media

Dr. David Buller, Klein Buendel’s Director of Research, and his coauthors have published results from the Health Chat Project in the online journal, Frontiers in Digital Health. Health Chat was designed as a social media intervention to reduce mothers’ permissiveness toward their teen daughters’ indoor tanning behavior. It also addressed other adolescent health topics, including human papillomavirus vaccination.

“Parents acquire information about human papillomavirus (HPV) vaccines online and encounter vaccine-critical content, especially on social media, which may depress vaccine uptake,” according to the authors. To help address vaccine hesitancy and misinformation, the authors employed a Facebook-delivered adolescent health campaign targeting mothers with posts on HPV vaccination. The study examined the relationship between mothers’ comments and reactions to posts about HPV and any change in their self-reports of having their daughters vaccinated.

The online publication describes the study’s hypotheses, social media health intervention, research methods, results, communication strategies, and limitations. The behavioral research was guided by social cognitive theory, transportation theory, and diffusion of innovations theory. In summary, mothers commented both positively and negatively toward HPV vaccine-related posts. Also, vaccinations rates increased from baseline, through 12-month and 18-month follow-up assessments.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kimberly Henry from Colorado State University; Jessica Bibeau from the University of Connecticut; Kelsey Arroyo from the University of Florida; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.