Who Gives a Hoot about Heat?

Who Gives a Hoot about Heat?

Extreme heat is the leading cause of weather-related deaths. Prevention includes personal practices and emergency procedures. Behavioral interventions to improve prevention of heat-related illnesses are a priority.

A multi-institutional research team led by Emory University and Klein Buendel has published a systematic review and narrative synthesis of behavioral interventions to improve heat-related illness prevention in community and occupational populations. The research team was assisted by a public health informationist from the Woodruff Health Sciences Center Library at Emory University. The paper has been published in the journal, BMC Public Health.

Utilizing systematic review methodology, a comprehensive search strategy was deployed to identify studies reporting evaluations of behavioral heat-illness prevention interventions. Data sources included prominent bibliographic databases and relevant grey literature searches. Inclusion criteria indicated that studies that enrolled adult participants, assessed heat-related outcomes quantitatively, and were published in English from January 2000 to October 2023 be included. Data on study design, intervention features, and outcomes from the retained studies were extracted. A narrative synthesis was conducted, given the small number of studies and heterogeneous features.

Seventeen articles reporting on results from 13 studies were retained. Samples included outdoor workers, professional athletes, or community members (20,154 participants). Study quality was variable, with only two studies classified as good quality. Outcomes assessed were cognitive variables (such as knowledge, attitudes, and intentions), behaviors (such as water intake and dehydration), and clinical indicators (such as kidney function). Seven studies evaluated a health education intervention, two studies tested warning messages, and two studies focused on provision of personal protection equipment. Interventions improved self-reported heat-illness knowledge and prevention behaviors, and reduced deaths. Kidney function and health were improved in two studies. 

The published literature on behavioral heat-related illness prevention interventions was limited, despite frequent periods of high heat. The published evidence suggested that interventions can improve prevention knowledge and behavior and possibly reduce heat injury. Study designs need substantial improvement by including larger samples and randomized designs with comparison groups to avoid threats to internal and external validity in existing data. Policy efforts should be considered along with health education and provision of personal protection equipment to ensure populations are adequately protected.

This research was supported by a grant (U48DP006377) from the Centers for Disease Control and Prevention to the Emory University Prevention Research Center (Dr. Alex Morshed from Emory University and Dr. David Buller from Klein Buendel, MPIs). Additional authors on this publication include Ms. Radhika Agarwal, Dr. Shenita Peterson, Dr. Cam Escoffery, and Ms. Kayla Anderson from Emory University; and Ms. Irene Adjei, Ms. Mary Buller, and Dr. Barbara Walkosz from Klein Buendel.

B-SMART App for DWI Offenders and Family Reduced Alcohol Use and Ignition Interlock Device Lockouts

B-SMART App for DWI Offenders and Family Reduced Alcohol Use and Ignition Interlock Device Lockouts

Driving while intoxicated (DWI) remains a preventable source of morbidity and mortality in the United States. Ignition interlock devices (IIDs) are used to prevent DWI offenders from driving while intoxicated during a mandated installation period and are effective during that time. Once IIDs are removed, DWI rates are like levels of offenders who had no IID.

Researchers at Klein Buendel and the University of New Mexico have published the results of a study that tested the efficacy of a new smartphone app (B-SMART) for DWI offenders with an IID and concerned family members, with the goal of reducing IID alcohol consumption and lockout events. The full paper with methods, analyses, and results has been published in the Journal of Studies on Alcohol and Drugs.

Four B-SMART app modules were developed: 1) Life with Interlock, 2) Supporting Changes in Drinking, 3) Doing Things Together, and 4) Effective Communication. Participants (pairs of DWI offenders and concerned family members) were randomly assigned to receive the B-SMART app (n=58) or referral to a state IID information page, considered usual and customary care (n=65), and followed for nine months. IID data (failed tests and lockout events) were obtained from IID providers as the primary outcome variables. Offender and CFM reports of alcohol consumption in the last 30 days prior to assessment were secondary measures.

IID data were collected on 62% (n=76) of participants. B-SMART participants had significantly fewer lockout events than usual and customary care participants. B-SMART offenders and their concerned family members reported significantly less likelihood of DWI offender drinking at the 9-month follow-up.

Results suggest the B-SMART app reduced DWI offender alcohol consumption and IID lockout events. These outcomes are important because fewer IID lockout events predict lower DWI recidivism.

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

Evaluation of Go Sun Smart Georgia

Evaluation of Go Sun Smart Georgia

The evaluation results of a workplace sun safety research project were presented at the 18th Annual Conference on the Science of Dissemination and Implementation in Health held December 14-17, 2025, in Washington, DC. Dr. Cam Escoffery from Emory University was the presenting author. The presentation complemented the conference theme of “Realizing the Benefits of Dissemination & Implementation Science.”

African American and Hispanic workers face unique skin cancer risks and are underrepresented in sun safety intervention research. To support sun safety practice in occupational settings with racially/ethnically heterogeneous populations, we adapted an evidence-based sun safety program—Go Sun Smart Georgia (GSSG)—to better serve African American and Hispanic outdoor workers and evaluated it in local governments. Program implementation outcomes are described.

The study enrolled seven local public employers in Georgia in 2024 and randomly assigned them to intervention (3 sites) or delayed intervention (comparison) group (4 sites), stratified by government type (municipal/county) and size (≥100/<100 employees). GSSG included training of peer coaches; written audit of the employers’ sun safety policies and practices; 45-minute online employee training; and a resource website. Program materials were adapted with culturally relevant language and imagery. GSSG was delivered over a four-month period in June-October. Implementation outcomes were collected via surveys and implementation logs: GSSG delivery, worksite sun safety policy adoption or modification, skin cancer and heat illness prevention practice use and penetration, and GSSG acceptability.

Two county governments and five municipalities (3 large, 2 small) in Southwest/East Georgia participated and 48 managers and 156 outdoor workers were assessed. Compared to the comparison group, outdoor workers in the intervention worksites had higher level of information about UV and heat protective behaviors; more workers recalled receiving skin cancer and heat training; and more reported sharing sun safety information from work at home. Uptake of GSSG policy components was slow; no sites requested a policy audit, one requested a model sun safety policy. Both managers and outdoor workers rated GSSG materials highly (an average of 4.29 out of 5 stars).

The adapted GSSG was well received and improved knowledge and sharing of sun safety practices among outdoor workers. Systematic adaptation of effective interventions for novel populations is important for increasing reach and impact of evidence in sun safety interventions and addressing disparities in cancer prevention.

This research was supported by a grant (U48DP006377) from the U.S. Centers for Disease Control and Prevention to the Emory University Prevention Research Center (Dr. Alex Morshed from Emory University and Dr. David Buller from Klein Buendel, Multiple Principal Investigators). Additional authors on the poster presentation included Mary Buller, Dr. Barbara Walkosz, and Irene Adjei from Klein Buendel; and Dr. Cam Escoffery, Helen Singer, April Hermstad, and Dr. Regine Haardörfer from Emory University. 

Mandatory Training Increases Drink Refusals to Intoxicated Patrons in California

Mandatory Training Increases Drink Refusals to Intoxicated Patrons in California

Klein Buendel scientists and staff are collaborators on a study that evaluated mandatory responsible beverage service training in California and its association with higher refusals of service to apparently intoxicated patrons in drinking establishments. The study, led by Dr. Robert Saltz at the Pacific Institute for Research and Evaluation, has been published in the Journal of Studies on Alcohol and Drugs.

The California Responsible Beverage Service (RBS) Training Act mandated training for all alcohol servers by 2023, giving this multi-institutional research team a rare opportunity to see how a statewide initiative might influence server behavior.

In 2022, 300 licensed on-premises establishments were sampled in nine counties in and around the San Francisco Bay Area. From July 2022 to January 2023, pseudo-patron and observer teams visited each establishment, and pseudo-patrons attempted to buy alcohol while displaying obvious signs of intoxication. The outcome of each purchase attempt and characteristics of establishments, servers, and pseudo-patrons, and month, day, and time, were recorded. In 2024, the same premises were visited as a follow up.

At baseline, 19.6% of the outlets refused service to the pseudo-patron. At follow up, the refusal rate increased significantly to 39.2% in a regression model controlling for establishment, server, and pseudo-patron characteristics. A typology of establishments (such as sports bar, casual restaurant, fine dining restaurant) did not show any association with refusal rate except that fine dining places refused more often than other types of establishments. Observers’ ratings of how obvious the pseudo-patron’s apparent intoxication was strongly associated with refusals.

The researchers conclude that there was substantial improvement in alcohol over-service refusals two years after the California mandatory RBS training law went into effect.

This research was funded by a grant to PIRE from the National Institute on Alcohol Abuse and Alcoholism (AA028772; Dr. Robert Saltz, Principal Investigator).  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.  

Feasibility of the STAC-T Bullying Bystander App

Feasibility of the STAC-T Bullying Bystander App

Bullying is a significant public health issue, with approximately 25% of middle school students reporting being a target of bullying in the past year. STAC is an evidence-based bullying bystander intervention for middle school students. A multi-institutional research team developed a technology-based version of STAC (STAC-T) and evaluated the acceptability and relevance of the program, as well as how acceptability and relevance are related to the use of specific skills (STAC strategies) students learn in the program. Significance, methods, data, and results have been published in the scientific journal, JMIR Formative Research.

STAC-T, which included a 40-minute training and a 15-minute booster session, was completed by 249 middle school students recruited from six middle schools in rural, low-income communities in the United States. Students completed a post-training survey assessing program acceptability and relevance, whether they witnessed bullying post-training, and the use of the STAC strategies to intervene in bullying situations. Descriptive statistics were used to assess acceptability, relevance, and the use of STAC strategies. Linear regression analysis was used to assess the relationship of program acceptability and relevance to STAC strategy use.

Most students reported the program was acceptable (82.1 to 90.0%) and relevant (78.6 to 83.0%) for students at their school; 88.8% (111) of the 50.2% (125) of students who witnessed bullying post-training also reported the use of at least one STAC strategy to intervene when witnessing bullying. Program relevance was a significant predictor of post-training use of STAC strategies. In contrast, program acceptability was not a significant predictor of post-training STAC strategy use.

This study provides support for the acceptability and relevance of STAC-T, as well as the effectiveness in promoting the use of the STAC strategies to intervene in bullying situations. Further, program relevance was related to STAC strategy use, highlighting the importance of assessing program relevance for specific student populations.  

The multi-institutional team was led by Dr. Aida Midgett from Boise State University. Collaborators included Dr. Diana Doumas, Taylor Perron, and Jennalyn Shelton from Boise State University; Dr. Robin Hausheer from the University of Vermont; Dr. Amanda Winburn from the University of Mississippi; and Brandon Herbeck and Mary Buller from Klein Buendel. The research was supported by a grant to Klein Buendel from the National Institute on Minority Health and Health Disparities (R42MD014943; Dr. Aida Midgett, Principal Investigator).

Just Care Simulated Usability Testing

Just Care Simulated Usability Testing

Growing numbers of people will grow old and die while incarcerated. A team from The Penn State University Ross and Carol Nese College of Nursing and Klein Buendel participated in a panel presentation at the Gerontology Society of America Annual Scientific Meeting on November 12-15 in Boston, MA, to discuss their research on caring for the aged and dying in prison.

The panelist, Dr. Erin Kitt-Lewis from Penn State, presented a pragmatic approach to the usability testing of Just Care. Just Care is a 7-module digital program to train people living in prison to assist staff by providing care to their peers who are older or dying. The web-based program educates prison staff on the needs of chronically ill, aging, and dying people who are incarcerated and provides implementation tools for providing care. Research evidence supports using peer caregivers to assist staff with geriatric and end-of-life care.

The Just Care team learned that gaining access to conduct research with external technology is limited at some correctional facilities as many are reassessing their technology capacity and policies, especially with limited staff. As a result, a pragmatic approach to conducting the research was necessary. In collaboration with the prison administration at one state prison system that had instituted restricted access to technology, an innovative approach — simulated usability testing — to test the program using focus groups was developed.

A total of six focus groups, two with staff and four with people living in prison, were held at one men’s and one women’s prison in a mid-Atlantic State; nine staff and 28 peer caregivers participated. The modified approach involved two on-site researchers conducting the focus groups while projecting the Just Care e-learning on a large screen and interacting with participants. Simultaneously, two off-site researchers connected via videoconference to screen share Just Care and take handwritten field notes. Participants were asked to comment on the content, feasibility, clarity, and ease of use of the program. 

Analysis of the qualitative data collected from the simulated usability testing resulted in three themes: barriers, facilitators, and future directions for the program. Each of these were described by the panelist in some detail.

This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging (AG057239; Dr. Susan Loeb from Penn State and Dr. Barbara Walkosz from Klein Buendel, Multiple Principal Investigators). Additional collaborators include Dr. Erin Kitt-Lewis, Dr. Kalei Crimi, and Nawal Alsearhi from the Ross and Carol Nese College of Nursing at Penn State University; and Amanda Brice and Steve Fullmer from Klein Buendel.

Helps and hindrances to passing state indoor tanning laws

Helps and hindrances to passing state indoor tanning laws

Indoor tanning causes skin cancers, including potentially deadly melanoma. Indoor tanning often starts during youth, a critical time for deleterious skin damage. About half of U.S. states have enacted laws banning indoor tanning for minors under the age of 18. A multi-institutional team of researchers including Dr. David Buller and Julia Berteletti from Klein Buendel has published a paper in Translational Behavioral Medicine that reports qualitative findings from interviews with key informants involved in indoor tanning legislative efforts to identify/describe factors influencing law enactment, based on the Multiple Streams Framework (1).

Guided by expert advisors and using snowball-sampling, 64 key informants from 16 states with most recently enacted indoor tanning laws regulating minor access and states without restrictions were contacted. In virtual interviews, key informants shared their unique “story” of indoor tanning bill efforts, enactment, implementation, impact, and potential future directions, which were transcribed and qualitatively coded by trained staff.

Although key informant roles (legislators, advocates, clinicians, and melanoma survivors) and legislative processes vary by state, similar facilitators and barriers to indoor tanning bill passage were identified: personal stories, advocacy, opposition, preparation, legislator education, economic/ enforcement issues, bill stringency, political values/partisanship, and legislative process. Other factors influencing bill enaction included failed U.S. Food and Drug Administration attempts toward federally banning minor indoor tanning and competing priorities.

Despite evidence of laws’ impact on minors’ indoor tanning, policy enaction is challenging and slow. Understanding key facilitators and barriers may help advocates to advance legislation efforts. Advocating for stringent laws necessitates consideration of potential downstream effects. For example, even with policy enactment, key informants believed enforcement and compliance were likely insufficient and variable, with minors continuing to indoor tan, putting them at risk for potentially deadly skin cancer.

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). Authors include Dr. Carolyn Heckman, Ms. Anna Mitarotondo, Mr. Kevin Schroth, and Dr. Shawna Hudson from Rutgers University; Dr. Jerod Stapleton from the University of Kentucky; Dr. Robert Dellavalle from the University of Minnesota; Dr. Sophie Balk from the Albert Einstein College of Medicine; and Dr. David Buller and Ms. Julia Berteletti from Klein Buendel.

References

  1. Kingdon JW. Agendas, Alternatives, and Public Policies. Longman, 2003.
Collaborator Spotlight:
Ms. Anne Poirier

Collaborator Spotlight:
Ms. Anne Poirier

Meet Klein Buendel’s newest research collaborator, Ms. Anne Poirier. She is the originator of the concept of body neutrality, which helps people step away from dieting and redefine their relationships with eating, their bodies, and themselves.

Ms. Poirier is the owner of a body neutrality coaching company and the author of books about self-care and compassion. She graduated from Plymouth State University with a bachelors’ degree in exercise science. She is also a graduate of the Eating Disorder Institute at Plymouth State University and the Life Coach Institute. She is an intuitive eating counselor, a self-talk trainer, and an NSCA-CSCS strength and conditioning specialist. She also serves on the National Eating Disorders Association Lived Experience Task Force.

Ms. Poirier is a nationally recognized body image expert and the author of The Body Joyful and Not a Fat Annie. She is a pioneer and leading voice for the body neutrality movement and has been featured and cited in major media outlets around the word including Shape, Women’s Health, New York Times, Washington Post, Newsy, Livestrong, ABC, and NPR. She is a long-time eating disorder survivor and certified self-talk trainer. She has been a guest on more than 50 podcasts. In 2015, she founded the company Shaping Perspectives…A Woman’s Way to Joy. The cornerstone of the company is the Body Joyful Solution, a coaching program based on the principles of body neutrality.

As her mission is to reduce bullying, body shaming, weight stigma, and eating disorders for the next generation, Ms. Poirier is collaborating with Klein Buendel Scientist, Dr. Kayla Nuss, on NoWeigh!, a novel approach to weight management. The NoWeigh approach emphasizes gratitude for the body’s function, a neutral attitude about the body’s appearance, and engagement in movement that is enjoyable, rather than weight loss. The NoWeigh! Project is funded by an SBIR grant from the National Institute of Diabetes, Digestive and Kidney Diseases (DK142209; Dr. Kayla Nuss, Principal Investigator).

TeenVac to Improve HPV Vaccine Uptake in Adolescent Boys

TeenVac to Improve HPV Vaccine Uptake in Adolescent Boys

Human papillomavirus (HPV) vaccine uptake remains below the Healthy People 2030 goal of 80% series completion in the United States. Parental concerns about the efficacy and safety of the vaccine remain and may be addressed by digital interventions tailored to their concerns.

Dr. W. Gill Woodall, Klein Buendel Senior Scientist, led a large study supported by the National Cancer Institute to increase HPV vaccination among adolescent boys . The results of the study have been published in the Journal of Adolescent Health. Specifically, the paper reports on the purpose, methods, and effectiveness of TeenVac, a mobile app to encourage HPV vaccination in families with adolescent boys.

A randomized trial was conducted between May 2019 and December 2020, testing the mobile web app (teenvac.org) that encouraged HPV vaccination for parents and sons aged 11–14 years old. Parents and 209 adolescent sons were randomized to receive either the TeenVac app or the Centers for Disease Control and Prevention (CDC) HPV vaccination pamphlet online. Participants had access to the TeenVac app or the CDC pamphlet for the 9-month study duration. Adolescent sons’ vaccination records were collected from the state vaccine registry at the end of the study.

Intent-to-treat and web usage analyses were conducted. Intent-to-treat analyses found that adolescent sons of parents randomized to the TeenVac app were significantly more likely to complete the HPV vaccination series than those randomized to the CDC pamphlet group. Web usage analysis confirmed that the TeenVac group parents who used the web app were significantly more likely to have sons complete the HPV vaccination series than those in the CDC pamphlet group.

The TeenVac app meaningfully impacted HPV vaccine series completion, particularly among parents who used the web app. The results provide further evidence that digital interventions can improve vaccine uptake when focused on parents’ and sons’ vaccine-related concerns.

This research was supported by a grant from the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Dr. Woodall’s coauthors include Dr. Gregory Zimet from Indiana University; Dr. Alberta Kong, Dr. Lance Chilton, and Dr. Tamar Ginossar from the University of New Mexico; Jennyfer Reither from Denver Health Hospital; and Dr. David Buller, Lila Martinez, Marita Brooks, and Noah Chirico from Klein Buendel.

Young Adult Melanoma Survivors and Family Member Skin Exams

Young Adult Melanoma Survivors and Family Member Skin Exams

Dr. David Buller, Director of Research at Klein Buendel, is a coauthor on a paper entitled, “Engagement in and correlates of total cutaneous exams and skin self-exams among young melanoma survivors and their family,” in the Journal of Behavioral Medicine.

Young adult melanoma survivors and their close family (first-degree relatives) are at increased risk for developing a melanoma. However, little is known about engagement in and correlates of their clinical skin examination and skin self-examination behaviors. Five hundred and seventy-four (574) young adult melanoma survivors and their first-degree relatives completed an online survey assessing engagement in clinical skin exam and skin self-exam. The survey also included measures of background factors, cognitive and psychosocial factors, clinical skin exam and skin self-exam planning, and family influences.

About 90% of young adults had a clinical skin exam and 90% performed skin self-examination in the last year. Engagement in clinical skin exams among first-degree relatives was lower. Being female, having a physician recommendation, having fewer barriers, and more planning were associated with clinical skin exams. Family influences were not associated with clinical skin exam. For skin self-exams, a physician recommendation and greater self-efficacy were associated with engagement. More comprehensive skin self-examination was associated with a physician recommendation, lower education, greater self-efficacy, and more planning. Stronger family normative influences were associated with more comprehensive skin self-exams among males.

Findings suggest that first-degree relatives may benefit from interventions to improve clinical skin exams and skin self-exams. These results also show that physician recommendation may be a key intervention target to stimulate clinical skin exams and skin self-exams. Examinations are vital for the early detection and effective treatment of melanoma. Details on the significance, methods, analyses, and results of the research may be found in the Journal of Behavioral Medicine manuscript.

This research was supported by a grant from the National Cancer Institute to the Rutgers Cancer Institute of New Jersey at Rutgers University (CA221854; Dr. Sharon Manne, Principal Investigator). Coauthors include Dr. Carolyn Heckman, Dr. Adam Berger, Sara Frederick, Alexandria Kulik, and Morgan Pesanelli from Rutgers University; Dr. Deborah Kashy from Michigan State University; Dr. Sherry Pagoto from the University of Connecticut; Dr. Susan Peterson from the University of Texas; Joseph Gallo from Hackensack Meridian Jersey Shore Medical Center; and Dr. David Buller from Klein Buendel.