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Economic Analysis of a School-based Sun Protection Program

Economic Analysis of a School-based Sun Protection Program

The U.S. Surgeon General and the Centers for Disease Control and Prevention have called on the nation’s schools to help prevent skin cancer by implementing sun safety practices and policies. The Sun Safe Schools program was designed by Klein Buendel researchers and collaborators in response to those calls to action. The program was implemented and evaluated with 118 public elementary schools in California school districts with formal sun safety policy. Administrators of schools randomized to the Sun Safe Schools intervention group received phone and email support for implementing school sun safety practices by trained coaches over 20 months.

A significant part of the program evaluation — an economic analysis — has been e-published ahead of print in the American Journal of Health Promotion. The lead author is Dr. Richard Meenan, a Senior Investigator and Health Economist from the Kaiser Permanente Center for Health Research in Portland, Oregon.

The publication reports the methods, analyses, results, conclusions, and limitations of the economic analysis. Sun Safe Schools program delivery costs were micro-costed and self-reported school practices were organized into ten categories that were assigned labor and non-labor costs. Across 53 intervention schools, per-student delivery costs averaged $0.69, of which $0.44 represented school administrator time. Program delivery costs, the costs of implementing sun safety practices (such as student education, parent outreach, and shade construction), and predictors of costs are detailed in the publication.

The authors conclude that a program of phone and email coaching of elementary school administrators in school districts with formal sun safety policies can stimulate implementation of sun safety practices at a reasonable cost. The results can assist school administrators with the implementation of sun safety practices.

The Sun Safe Schools program was a collaborative research effort of Claremont Graduate University (CGU), the Kaiser Permanente Center for Health Research, and Klein Buendel. The research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds, CGU, and Dr. David Buller, Klein Buendel, Multiple Principal Investigators). Other collaborators included Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Kim Massie previously from CGU; and Julia Berteletti, Xia (Lucia) Liu, and Mary Buller from Klein Buendel.

Physical Activity Intervention for Older Adults

Physical Activity Intervention for Older Adults

In a publication in the Journal of the American Geriatrics Society, Dr. Nancy Glynn from the University of Pittsburgh, Klein Buendel’s Senior Scientist Dr. Valerie Myers, and several other contributors evaluate the effectiveness of the Lifestyle Interventions and Independence for Elders (LIFE) study.

The LIFE study was a randomized controlled trial designed to compare a moderate-intensity physical activity intervention with a health education program for sedentary older persons, 65 years or older, with low physical activity who are at risk for major mobility disability. LIFE’s primary goal was to investigate whether physical activity is an effective and practical way for preventing major mobility disability in older persons, which is defined as the inability to walk 400 meters.

For the study, participants at multiple centers were asked to perform a 400-meter walk at a normal pace every six months at which various measurements were assessed and calculated including baseline fatigue, self-reported fatigue, and energy levels. The physical activity intervention incorporated lower extremity resistance exercises, balance exercises, stretching and behavioral counseling. Health education seminars were also provided with information available about health-related matters and involved various upper extremity stretching exercises.

To learn more about the physical activity intervention and if it was effective at preserving the mobility of older adults, you can view a full description of the methods, results, and discussion in the publication.

This research was funded by a grant from the National Heart, Lung, and Blood Institute and the National Institute on Aging (AG022376; Marco Pahor, MD, University of Florida, Principal Investigator). Dr. Myers is one of the paper’s 16 authors, including the Interventions and Independence for Elders Study Group.

Hispanic Tattoo Artists as Skin Cancer Prevention Influencers

Hispanic Tattoo Artists as Skin Cancer Prevention Influencers

Skin cancer is increasing in the Hispanic population and there is a public health need for campaigns to target this often-underrepresented population. In a recent publication in The Journal of Drugs in Dermatology (JDD), authors from the University of Colorado School of Medicine and Klein Buendel examine how Hispanic tattoo artists can serve as skin cancer prevention advocates for the Hispanic population. JDD also released a podcast with the authors about the study earlier this month.

Multiple in-depth interviews were conducted with Hispanic tattoo artists at various tattoo studios in Salt Lake City, Utah. The interviews provided insight into the artist’s skin cancer knowledge, their current sun safety recommendations to clients, and their willingness to incorporate skin cancer prevention into their future work routines.

Data analysis indicated that a most of the artists had a large percentage of Hispanic clients and repeat customers. All artists also had some level of skin cancer knowledge, though not extensive enough to provide basic sun protection tips in their regular tattoo aftercare instructions to clients (such as what specific Sun Protection Factor to use, when to reapply sunscreen, and the use of cover up clothing). Despite this, all artists were enthusiastic about providing sun safety messages on their social media pages and would be willing to partake in some level of skin cancer prevention training and education in the future.

With lengthy tattoo sessions and repeat clientele, Hispanic tattoo artists could serve as beneficial influencers in the early detection of skin cancers in the Hispanic population. Researchers concluded that by providing comprehensive full-body sun protection information to their clients through tattoo aftercare instructions, alerting clients to suspicious moles, and using social media messages, Hispanic tattoo artists could have a big impact on their clients’ skin health. The study’s complete analysis and discussion can be found in the publication.

This project was funded by a grant and a supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Authors include Dr. Cristian Gonzalez, and Dr. Adrian Pona from the University of Colorado School of Medicine; Dr. Barbara Walkosz from Klein Buendel; and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the U.S. Department of Veterans Affairs Rocky Mountain Regional VA Medical Center Dermatology Service.

ID Compliance by Recreational Marijuana Stores in Two States

ID Compliance by Recreational Marijuana Stores in Two States

The recreational sale of marijuana has begun in ten U.S. states and seems likely to expand to several others. Only state-licensed stores can sell recreational marijuana products and only persons over age 21 who provide a valid state-approved identification (ID) can enter the stores and purchase marijuana. The age and ID regulations are intended to prevent youth gaining access to recreational marijuana, and it is important to investigate whether these age and ID restrictions are actually working.

Research collaborators from Klein Buendel and the Pacific Institute for Research and Evaluation, measured compliance with age and ID regulations by state-licensed recreational marijuana stores in two states and reported their findings in the Journal of Studies on Alcohol and Drugs. The paper reports assessment of sale refusal rates in a large, diverse sample of stores selling recreational marijuana in the states of Colorado and Washington. The paper’s analyses describe ID checking behavior by store personnel, estimate refusal rates, and explore factors associated with refusal. 

One hundred seventy-five recreational marijuana stores in Colorado and Washington were visited twice by pseudo-buyer assessment teams in September 2016 to April 2017. A young-adult buyer attempted to enter the store and purchase marijuana without showing a state-approved identification. In the second Colorado visit, a buyer aged 18-20 showed an underage driver’s license and attempted to enter the store and purchase marijuana. No cannabis products were actually purchased.

All stores requested an ID. Stores refused buyers in 73.6% of visits at the entrance, 88.3% cumulative before the counter, and 92.6% cumulative by the time of a purchase attempt. Refusal was lower in Washington than in Colorado but it did not differ by buyer protocol. Overall, compliance with laws restricting marijuana sales to individuals 21 or older with a valid ID was high. The authors suggest that compliance in Washington might be improved by having store personnel check IDs at the store entry. Recreational stores may not be selling marijuana directly to youth, although no information was collected on straw purchases. The measures, methods, analyses, results, conclusions, and limitations are detailed in the publication.

This research was funded by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Coauthors include Dr. Gill Woodall and Ms. Mary Buller from KB, and Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation.

Preventing Alcohol and Drug Overuse Among Nightclub Patrons

Preventing Alcohol and Drug Overuse Among Nightclub Patrons

Nightclubs are high-risk settings for overuse of alcohol and other drugs. In a July publication in the Journal of Studies on Alcohol and Drugs, collaborators from the Pacific Institute for Research and Evaluation (PIRE), the University of California San Francisco, and Klein Buendel reported the outcomes of their intervention to protect nightclub patrons from substance abuse and harmful consequences.

Nightlife Safety Plans (NSP) is a group-based, tablet app-delivered intervention designed for groups of patrons arriving at nightclubs together. NSP encourages social groups to recognize early indicators of risk and take actions steps to de-escalate risky situations, such as physical and sexual aggression, through peer influence and other methods. The intervention was designed around a simple mnemonic – the three O’s: Outreach, Options, and Out:

  • Outreach: “provide outreach by approaching the friend and checking in, using nonconfrontational approaches”
  • Options: “provide options to a group member if a problem is identified”
  • Out: “know when the group should get out of the club to avoid further problems”

A total of 959 people from 352 social groups participated in the intervention at 41 different electronic music dance events at nightclubs in San Francisco, California. The measures (including breath samples for blood alcohol concentration and oral fluid samples for drug use), methods, analyses, results, discussion, and limitations are detailed in the publication.

In summary, intervening in the right place at the right time with peer influence strategies proved to be effective. The authors report that the NSP app appeared to increase protective actions to keep group members safe from overuse of alcohol and other drugs in these high-risk environments.

This research was funded by a grant to the Prevention Research Center at PIRE from the National Institute on Alcohol Abuse and Alcoholism (AA022331; Dr. Brenda Miller, Principal Investigator). Authors of the publication include Dr. Hilary Byrnes, Dr. Brenda Miller, Dr. Mark Johnson, and Veronica Rogers from PIRE; Dr. Beth Bourdeau from the University of California San Francisco; and Dr. David Buller and Julia Berteletti from Klein Buendel. The NSP tablet app was developed by Klein Buendel’s Creative Team.

Ultraviolet Radiation and the Fading of Colored Tattoos

Ultraviolet Radiation and the Fading of Colored Tattoos

In a recent publication in Photodermatology, Photoimmunology and Photomedicine, authors from the University of Colorado School of Medicine and Klein Buendel examine a case and describe how ultraviolet radiation (UVR) may affect tattoos by causing abnormal healing, premature fading, scabbing, and scarring.

The case under review revolved around a male patient with Fitzpatrick skin type III who presented concerns about a colored tattoo that had visibly undergone premature fading. In addition to a physical exam, the patient’s outdoor habits, medical history, and sun safety behaviors were also documented. The patient had visible uneven distribution of red and yellow pigment in the tattoo on his arm. The full report, discussion, and conclusion can be found in the publication.

Although tattoo fading is a multifaceted process, excessive UVR exposure can be a preventable factor. By taking simple measures such as wearing sunscreen greater than SPF 30, wearing sun protective clothing, and seeking shade, individuals can minimize unnecessary sun exposure to protect their skin and tattoos.

This project was funded by a grant and a supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Paper authors include Dr. Cristian Gonzalez, Dr. Chandler Rundle, and Dr. Adrian Pona from the University of Colorado School of Medicine; Dr. Barbara Walkosz from Klein Buendel; and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the U.S. Department of Veterans Affairs Rocky Mountain Regional VA Medical Center Dermatology Service.

Melanoma Receptor Variation in a New Mexico Population

Melanoma Receptor Variation in a New Mexico Population

Dr. David Buller, KB Senior Scientist and Director of Research, is a co-author on a paper published recently in Cancer Epidemiology, Biomarkers & Prevention. The paper examines the Melanocortin 1 Receptor (MC1R) in a multicultural New Mexican population. MC1R is a risk factor for developing melanoma skin cancer because it contributes to skin pigmentation. The paper’s lead author is Dr. Kirsten White from the University of New Mexico. Other co-authors are from the Memorial Sloan Kettering Cancer Center in New York, the University of Utah, and the University of New Mexico.

Specifically, single-nucleotide polymorphisms (SNPs) in MC1R and their association with race and ethnicity, skin type, and perceived cancer risk were evaluated by genotyping MC1R in 191 primary care clinic patients in Albuquerque, New Mexico. A full description of the methods, results, conclusions, and limitations of the research can be found in the publication.

Overall, the authors concluded that a specific variant of interest in MC1R may not be a risk factor for melanoma among New Mexican Hispanics, and that genetic risk cannot be inferred from Northern European populations directly to non-European populations.

Economic Evaluation of Adopting Occupational Sun Protection Policies

Economic Evaluation of Adopting Occupational Sun Protection Policies

In a recent publication in the Journal of Occupational and Environmental Medicine, Klein Buendel investigators and their colleagues discuss the economic evaluation of an intervention promoting adoption of occupational sun protection actions by Colorado public-sector employers.

The intervention, Sun Safe Workplaces (SSW), was a two-year randomized field trial promoting employer adoption of sun safety policy and providing training in personal sun protection for outdoor workers. The trial included 98 local Colorado government organizations such as municipalities, counties, and special districts (public organizations providing water, sanitation, parks and recreation, and fire protection). SSW intervention costs were organized into two components: “delivery” costs and “action” costs. Delivery costs were incurred to directly implement and maintain the SSW intervention and included costs of both project staff and the participating worksites. Action costs were incurred by the worksites themselves for implementing the sun protection actions.

The publication presents the results of the economic evaluation of SSW. A full description of the methods, measures, results, and conclusion of the research can also be found in the Journal of Occupational and Environmental Medicine publication.

This study demonstrated the interactions of cost and implementation that explain — and hopefully guide — the adoption of and investment in occupational sun safety. The SSW intervention was also successful in extending the adoption of sun protection actions among intervention worksites at a cost per employee that is comparable to other worksite health interventions.

This analysis was funded by a grant from the National Cancer Institute at the National Institutes of Health (CA134705; Dr. David Buller and Dr. Barbara Walkosz, Multiple Principal Investigators). The paper’s lead author is Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Oregon. Additional authors include Dr. David Buller, Dr. Barbara Walkosz, Ms. Mary Buller, Ms. Rachel Eye, and Ms. Savanna Olivas from Klein Buendel; and Dr. Allan Wallis from the University of Colorado Denver.

Using Panel Vendors to Recruit Research Participants

Using Panel Vendors to Recruit Research Participants

It has become more common to recruit research study participants through online panel vendors, such as GfK or Qualtrics. In a publication made available recently in PubMed Central from Evaluation and the Health Professions, Dr. Meme Wang-Schweig from the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE) and her coauthors (including Dr. David Buller from Klein Buendel), report on the use of panel vendors for recruiting research participants into a randomized controlled trial. The research study was testing an online, family-based alcohol prevention program for parents and older teens, called Smart Choices 4 Teens.

Panel vendors are hired to recruit and match potential research participants to a target population for data collection.  Most panel vendors use non-probability sampling which does not involve random selection. People opt in to participate. The vendors advertise for panelists using website banner ads, emails, direct mail, etc. Panelists are paid but may also enjoy contributing their opinions to a research study. Panel vendors can recruit a potential research sample quickly.

Dr. Wang-Schweig’s paper endeavors to answer two methodological questions: (1) how well do panel vendors provide a sample of families to participate in a trial who meet specific inclusion criteria, and (2) how well do panel vendors provide a sample of families to participate in a trial who reflect the make-up of the general population? Using the Smart Choice 4 Teens project’s experience as a real-world example, the authors describe the process of working with panel vendors, the sample’s match to the intended target population, and the additional screening they employed to ensure the quality of the sample. Several recommendations are made for other research teams looking to use panel vendors to recruit study participants.

Smart Choice 4 Teens was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA020977; Dr. Brenda Miller, PIRE, Principal Investigator). Dr. Wang-Schweig’s coauthors for this publication included Dr. Brenda Miller, Dr. Hilary Byrnes, Dr. Beth Bourdeau, and Ms. Veronica Rogers from PIRE; and Dr. David Buller from Klein Buendel.

The Importance of Managers’ Awareness of Sun Protection Policy

The Importance of Managers’ Awareness of Sun Protection Policy

Improving occupational sun protection is a priority in the United States, as The Surgeon General’s Call to Action to Prevent Skin Cancer highlights. Klein Buendel and its collaborators responded to the call by launching a randomized trial to evaluate the effectiveness of a workplace sun protection program for outdoor workers. The program, Sun Safe Workplaces, was implemented with 98 public employers in Colorado, a state with high ultraviolet radiation due to its high elevation and sunny climate. The intervention promoted the adoption or strengthening of sun safety policy and the implementation of employee sun protection training. A two-year follow-up study also was completed with 68 of the 98 public sector employers.

In a recent publication in the American Journal of Industrial Medicine, Dr. Barbara Walkosz, Klein Buendel Senior Scientist, and her coauthors reported results related to the hypothesis that senior managers’ awareness of sun protection policy in the workplace would predict increased sun safety practices by employers and employees who work outdoors.

A full description of the methods (questionnaires and on-site observations), results, conclusions, and limitations of the research can be found in the American Journal of Industrial Medicine publication. In general, more sun safety messages, manager-employee communication, sun safety practices, and sun protection equipment (sunscreen, hats, etc. ) were evident when senior managers were more aware of their organization’s sun protection policy.

Overall, the authors found that occupational sun protection programs can be more effective on the “front line” (with people who work outdoors) when the “back office” (senior management) is aware of and can, therefore, support and encourage their organization’s sun safety policies and practices.

This analysis was funded by a grant from the National Cancer Institute at the National Institutes of Health (CA134705; Dr. David Buller and Dr. Barbara Walkosz, Principal Investigators). Dr. Walkosz’s coauthors on this paper included Dr. David Buller, Ms. Mary Buller, and Ms. Xia (Lucia) Liu from Klein Buendel, and Dr. Allan Wallis from the University of Colorado Denver.