Collaborator Spotlight: Colorado Investigators on the #4Corners4Health Project

Collaborator Spotlight: Colorado Investigators on the #4Corners4Health Project

Thirteen scientists from universities and NCI Comprehensive Cancer Centers in Arizona, Colorado, New Mexico, and Utah are collaborating with Dr. David Buller, Klein Buendel’s Director of Research, on the #4Corners4Health study (CA268037). The 4Corners study aims to aid rural emerging adults (ages 18-26 years) in making informed decisions that reduce cancer risk factors and prevent cancer later in life and help emerging adults evaluate and resist misinformation and marketing that promote cancer risk behaviors. This will be accomplished using a social media campaign designed with community advisors for diverse young adults living in rural counties in the Four Corners states (AZ, CO, NM, and UT). Social media may reach emerging adults more than interventions through other community channels (for example, clinics, schools, and workplaces) and for lower cost in the geographically-dispersed, underserved rural communities in the Mountain West.

This Collaborator Spotlight features the Co-Investigators from Colorado, outside of Klein Buendel. Dr. Barbara Walkosz and Dr. W. Gill Woodall from Klein Buendel are also Co-Investigators on this project.

Dr. Douglas Taren, PhD, MS, has degrees in Math, Chemistry, and Nutritional Sciences from the University of Arizona, and a doctorate in International Nutrition from Cornell University (International Nutrition). He is currently a Professor of Pediatrics (Nutrition Section) at the University of Colorado, Anschutz Medical Campus. He is also a Professor Emeritus in the Health Promotion Sciences Department at the School of Public Health at the University of Arizona.

Dr. Taren’s research focuses primarily on maternal and child nutrition with a special emphasis on decreasing health disparities within low income populations and countries. He is specifically interested in domestic and global food security issues, local food systems, clinical and public health approaches to child weight management, the evaluation of humanitarian food aid programs, and dietary interventions. Some of his recent projects have included evaluating the impact of solar market gardens for small landowners that use solar-powered drip irrigation on health outcomes, the interaction between food safety and nutrition and how food systems impact the development of risk factors for type 2 diabetes in children.

As an international scholar, his studies and teaching experiences in maternal and child health have been conducted in several Latin American, Asian and African countries with funding from numerous organizations including USAID, FAO, NIH, CDC, and the Elizabeth Glaser Pediatric AIDS Foundation.  These projects have focused on food security programs with organizations such as Save the Children, Counterparts International, TANGO International and the World Food Program.  He has worked on improving programs that prevent and treat vitamin A deficiency in Nepali pregnant women and young children, and effectiveness studies on decreasing mother-to-child HIV transmission in Kenya. He has also worked on improving dietary assessment methods and community-based programs to decrease childhood obesity. Dr. Taren has served as a resource person to the World Health Organization Nutrition Guidance Expert Advisory Group Monitoring and Evaluation Subgroup on Guidelines for the Assessment of Vitamin A and Iron Status in Populations. 

Dr. Evelinn Borrayo, PhD, MA, is a Professor, the Associate Director of Research at the Latino Research and Policy Center in the Department of Community and Behavioral Health, and the Associate Director for Community Outreach and Engagement in the Cancer Center at the University of Colorado, Anschutz Medical Campus. She was trained in clinical health psychology and has served as an appointed and voting member of the Colorado Board of Health.

Dr. Borrayo’s research interests include cancer prevention, equity and social justice, health disparities, health outcomes, and Latina/Latino health. Her research focuses on health disparities in the prevention, control, and treatment of cancer among medically underserved Latinos. Her research projects have focused on the psychological, cultural, and social factors involved in cancer prevention and control and in the treatment of lung and head-and-neck cancers among Latinas and Latinos affected by these cancers. She conducts research in both community-based and medical settings.

Kimberly Henry, PhD, is a Professor of Applied Social and Health Psychology in the Department of Psychology at Colorado State University. She received her doctorate in biobehavioral health from Penn State University.  Dr. Henry’s areas of research expertise include school disengagement, adolescent and young adult development, drug use, delinquency, and longitudinal methodology. Her focus is on the psychological and social factors that produce or mitigate the health-risking behaviors of adolescents and young adults. Her goal is to develop and test theoretical models in order to understand the complex interactions of risk, promotive, and protective factors that influence risky behaviors and to create and test methods for prevention.

Serving Alcohol to Obviously Intoxicated Patrons

Serving Alcohol to Obviously Intoxicated Patrons

Klein Buendel scientists and staff are co-authors on a new publication of research results with scientists from the Pacific Institute for Research and Evaluation (PIRE) in the Journal of Studies on Alcohol and Drugs (JSAD). The study, led by PIRE, examines alcohol over-service at bars, nightclubs, restaurants, etc. in California which is associated with driving while intoxicated, violence, and other problems.

Three hundred licensed bars, night clubs, restaurants, etc. were sampled in 2022 in nine counties representing the San Francisco Bay Area. Combination pseudo-patron and observer teams visited each on-premise establishment where the pseudo-patrons attempted to buy alcohol while displaying obvious signs of intoxication. The JSAD paper describes characteristics of the establishments, servers, pseudo-patrons, and time/date of purchase attempt that may be associated with the refusal of alcohol service.

In total, 21% of the establishments refused alcohol service to pseudo-patrons. Descriptive and regression analyses were conducted and are described in detail in the JSAD publication. According to the authors, “No establishment or server characteristics were significantly associated with service refusal in logistic regression analysis; nor were month, day, or time.” However, service refusal was significantly more likely for female pseudo-patrons and pseudo-patrons displaying obvious or very obvious signs of intoxication.

The authors assert that the study indicates that alcohol over-service to obviously intoxicated patrons remains common at licensed on-premises establishments. Mandatory responsible beverage service training of servers and enforcement of alcohol over-service laws was recently enacted in California, which may help to reduce over-service and its related problems.

This study is sponsored by a grant from the National Institute on Drug Abuse (AA028772; Dr. Robert Saltz, Principal Investigator, PIRE). Co-authors include Dr. Mallie Paschall and Dr. Sharon O’Hara from PIRE, and Dr. W. Gill Woodall, Dr. David Buller, and Ms. Lila Martinez from Klein Buendel.  

2023 Research Highlights

2023 Research Highlights

Klein Buendel scientists and staff continued to pursue rigorous behavioral science research with numerous national and international collaborators. Our creative team also designed and engineered multiple web-based programs to positively impact the health and safety of people’s everyday lives.  

In 2023, we started three new research projects with diverse collaborators. We published (or e-published ahead of print) six research papers in peer-reviewed journals and six additional publications are in press for early 2024. We presented research analyses and outcomes at six national or international conferences.  

In March, Ms. Marita Brooks retired from Klein Buendel after working with Dr. Gill Woodall for over 30 years at the University of New Mexico (CASAA) and Klein Buendel (as a Senior Research Project Coordinator).  

In April, we hosted Ron Borland, PhD, FASSA, Professor of Psychology and Health Behavior from the University of Melbourne in Victoria, Australia. His focal presentation was entitled, “Can we eliminate smoking without embracing harm reduction?” 

In May, Dr. David Buller was a speaker at the 7th Annual Conference of the UCONN Center for Health and Social Media. His presentation was entitled, “How can public health better utilize social media? Challenges and opportunities.”  

In October, Dr. Buller participated in a panel discussion on measures, data sources, and data collection strategies at the New York University Policy-Focused Implementation Science Training. He discussed his research on responsible vendor practices and training in state-regulated alcohol markets aimed at reducing DUI and other harms of over-service of alcoholic beverages. 

In October, Dr. Buller also joined Carolyn Heckman from Rutgers University to present an update and preliminary findings from an investigation of state indoor tanning laws to the National Council for Skin Cancer Prevention. The presentation covered the nature of state laws, the political process that led to their passage or failure, and compliance with state regulations pertaining to minor access and other regulations on indoor tanning facilities. 

In December, Dr. Gill Woodall gave a presentation to the New Mexico Immunization Coalition. The presentation reviewed the effectiveness of the TeenVac web app on improved HPV vaccine uptake. 

Projects Launched in 2023 

  1. “Feasibility and design of a novel smartphone app to deliver blood pressure-lowering inspiratory muscle strength training.” Phase I STTR grant to Klein Buendel from the National Heart, Lung, and Blood Institute (HL167375; Dr. Douglas Seals, Principal Investigator, University of Colorado). The primary Co-Investigator from Klein Buendel is Dr. Kayla Nuss. 
  1. “Policy and training intervention in responsible marijuana sales practices to reduce the risk of selling to intoxicated customers.” A 5-year R01 grant from the National Institute on Alcohol Abuse and Alcoholism (AA031591; Dr. W. Gill Woodall and Dr. David Buller, Multiple Principal Investigators).  
  1. “Beyond Blame: Development of an online media literacy curriculum for violence prevention.” A Phase I SBIR grant from the Centers for Disease Control and Prevention (CE003635; Dr. Barbara Walkosz, Principal Investigator).  

For these new projects, we are collaborating with the following primary investigators, universities, and organizations: 

  • University of Colorado, Boulder (Dr. Douglas Seals) 
  • Pacific Institute for Research and Evaluation (Dr. Robert Saltz) 
  • NORC at the University of Chicago ((Mr. Jim Fell) 
  • Center for Media Literacy (Ms. Tessa Jolls) 

2023 Publications* 

  1. Manne S, Pagoto S, Peterson S, Heckman C, Kashy D, Berger A, Studts C, Megron R, Buller D, Paddock, Gallo, Kulik A, Frederick S, Pesanelli M, Domider M, Grosso M. Facebook Intervention for Young-Onset Melanoma Survivors and Families: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2023 Jan 24;12:e39640. 
  1. Ray AE, Mun E, Lewis MA, Litt DM, Stapleton JL, Tan L, Buller DB, Zhou Z, Bush HM, Himelhoch S. Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students: Protocol for a Hybrid Type 1 Effectiveness-Implementation Trial. JMIR Res Protoc. 2023 Mar 20:12:e43986. doi: 10.2196/43986. 
  1. Nuss K, Sui W, Rhodes R, Liu S. Motivational Profiles and Associations With Physical Activity Before, During, and After the COVID-19 Pandemic: Retrospective Study. JMIR Form Res. 2023 Apr 24;7: e43411. doi: 10.2196/43411. 
  1. Nuss K, Moore K, Marchant T, Courtney JB, Edwards K, Sharp JL, Nelson TL, Li K. The combined effect of motivational interviewing and wearable fitness trackers on motivation and physical activity in inactive adults: A randomized controlled trial. J Sports Sci. 2023 Mar 25:1-11. doi: 10.1080/02640414.2023.2195228. 
  1. Moore KN, Nuss K, Do B, Wang SD, Li K, Graham DJ, Dunton GF, Courtney JB. Motivational Profile as a Predictor of Physical Activity Among US Adults During the Early Months of the COVID-19 Pandemic: A Daily Diary Study. J Phys Act Health. 2023 Jul 28;20(10):963-970. doi: 10.1123/jpah.2022-0474. 
  1. Saltz R, Pashcall MJ, O’Hara S, Buller DB, Woodall WG, Martinez L. Serving alcohol to an “obviously intoxicated” patron. J Stud Alcohol Drugs. 2023 Dec 11. doi: 10.15288/jsad.23-00253. Online ahead of print. 

*KB investigators and staff are indicated in bold type  

2023 Conference Presentations 

Research progress, analyses, and outcomes were presented and disseminated by Klein Buendel scientists, staff, and their collaborators at the following national and international conferences in 2023: 

  • EUROGIN International Multidisciplinary HPV Congress (February)  
  • 44th Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine (April) 
  • 46th Annual Scientific Meeting of the Research Society on Alcoholism (June) 
  • Custody and Caring: 18th Biennial International Conference on the Nurse’s Role in the Criminal Justice System (September) 
  • 14th Conference of the European Society for Prevention Research (October) 
  • 16th Annual Conference on the Science of Dissemination and Implementation in Health (December) 

Dissemination & Implementation Conference

Dissemination & Implementation Conference

Three occupational sun safety projects were presented by collaborating researchers from Klein Buendel and Emory University at the 16th Annual Conference on the Science of Dissemination and Implementation in Health held December 10-13, 2023, in Washington, DC. Each presentation complemented the conference theme of “Raising Expectations for Dissemination & Implementation Science: Challenges and Opportunities,” by approaching occupational skin cancer prevention in a unique and challenging way.  

Poster 1 

Title: Differences in Program Implementation and Sun Protection of an Occupational Sun Safety Intervention: Comparison of Two Dissemination Strategies 

Presenter: Dr. David Buller, Klein Buendel 

Dr. David Buller

Balancing effectiveness and cost is essential when scaling up evidence-based interventions. In this study, two methods for disseminating an evidence-based occupational sun protection intervention that differed in cost and personal contact were compared. Solar ultraviolet radiation is a carcinogen associated with skin cancer. 

Sun Safe Workplaces (SSW), a policy and education intervention, was effective in a randomized trial in Colorado (1,2). Two methods for disseminating SSW were compared in a randomized pretest-posttest two-group trial design. State departments of transportation (DOTs; n=21) participated and the 136 districts within these DOTs were randomly assigned to receive SSW either by an in-person coaching method or a virtual coaching method. In each district, managers were pretested prior to randomization (n=1,484) and posttested (n=289) after 29-40 months (timing and attrition were affected by the COVID pandemic) on implementation of SSW training and communication and personal sun protection practices. Employees (n=1,388) also were posttested on training and communication implementation and personal sun protection practices. 

There was no difference in managers’ reported implementation of sun protection actions at the workplace between dissemination methods. But more employees reported receiving sun protection training in in-person (60%) than virtual (46%) dissemination method and being more favorable toward this training (in-person M=3.70, virtual M=3.60.) Managers at workplaces receiving SSW via in-person dissemination experienced fewer sunburns in the past year while working outdoors than with virtual program delivery (M=0.69 v. M=1.58 sunburns; estimate=-0.875, p<0.011), especially at workplaces receiving it before the pandemic compared to later in the pandemic (in-person=0.43, virtual=0.79). 

Effectiveness of evidence-based programs when scaled-up may be affected by the method of dissemination. Here, in-person coaching may have increased implementation of SSW training. It also may have aided coaches in convincing managers that there was a need for occupational sun safety and motivated them to avoid sunburn themselves and work to make employees see the value in training. The virtual delivery method may not have affected employees’ personal protection because they had limited contact with the coaches. Pandemic restrictions may have reduced intervention success. 

This research was supported by a grant (CA210259; Dr. David Buller, PI) from the National Cancer Institute at the National Institutes of Health. Coauthors on this poster presentation included Ms. Julia Berteletti and Ms. Mary Buller from Klein Buendel; Dr. Kimberly Henry from Colorado State University; Dr. Richard Meenan from Kaiser Permanente, and Dr. Gary Cutter from the University of Alabama. 

References 

  1. Buller, D. B., Walkosz, B. J., Buller, M. K., Wallis, A., Andersen, P. A., Scott, M. D., Eye, R., Liu, X., & Cutter, G. R. (2018). Results of a randomized trial on an intervention promoting adoption of occupational sun protection policies. American Journal of Health Promotion, 32, 1042-1053. 
  2. Walkosz, B. J., Buller, D. B., Buller, M. K., Wallis, A., Meenan, R., Cutter, G., Andersen, P. A., & Scott, M. D. (2018). Sun safe workplaces: Effect of an occupational skin cancer prevention program on employee sun safety practices. Journal of Occupational and Environmental Medicine, 60, 900-997. 

Presentation 1 

Title: Adaptation of an Evidence-based Occupational Sun Safety Program for Underserved Outdoor Workers in Southwest Georgia

Presenter: Dr. Alex Morshed, Emory University 

Dr. David Buller, Ms. Mary Buller, Dr. Alex Morshed, Dr. Cam Escoffery

African American and Hispanic workers face unique skin cancer risks from UV exposure and are underrepresented in occupational sun safety research. This presentation reported on adaptation of an existing evidence-based sun safety program—Go Sun Smart at Work—to predominantly African American and Hispanic outdoor workers in local government employers in Southwest Georgia. The adaptation is renamed Go Sun Smart Georgia.

The systematic adaptation process was informed by Dr. Cam Escoffery’s Key Adaptation Steps (1), Implementation Research Logic Model (IRLM) (2), and the Framework for Reporting Adaptations and Modifications (3). The original intervention promotes workplace policy and education to improve sun protection and was effective in a randomized trial in Colorado (4,5). The team mapped the program and delivery using IRLM and developed an adaptation tracking tool based on Rabin et al. (6) to catalogue and make decisions about potential adaptations. The team integrated multiple sources of information to identify compatible and feasible adaptations: consultation with program experts and community partners, qualitative data collection with outdoor workers and managers at two local government employers (Jul-Sep 2023), and synthesis of literature. 

The intervention includes training of peer coaches; written audit of employer sun safety policies, practices; employee training; and resource website (for example: training, sample policies, print materials, videos). In a pilot study with two local government employers, 11 employees identified by senior managers completed virtual 30-minute instruction to be peer coaches. Peer coaches delivered the sun safety training at staff meetings (21-39 employees per session). Several promising adaptations were identified, including modification of educational materials to better represent the worker population, addressing misconceptions, and use of external peer coaches at the workplace. Interviews with managers and focus groups with employees are in process.  

Adaptation of existing, effective interventions to better address population characteristics and needs can increase feasibility and scalability with employers throughout Georgia, which furthers dissemination and reach of existing evidence base for improving occupational sun safety and preventing cancer. 

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). Coauthors on this oral presentation included Ms. Mary Buller, Dr. Barbara Walkosz, Ms. Irene Adjei, Mr. Brandon Herbeck, and Dr. David Buller from Klein Buendel; and Ms. Kayla Anderson, Dr. Cam Escoffery, and Radhika Agarwal from Emory University. 

References 

1.Escoffery et al. 2019. https://doi.org/10.1093/tbm/ibx067 

2.Smith et al. 2020. https://doi.org/10.1186/s13012-020-01041-8 

3.Wiltsey Stirman et al. 2019. https://doi.org/10.1186/s13012-019-0898-y 

4.Buller et al. 2017. https://doi.org/10.1177/0890117117704531 

5.Walkosz et al. 2018. https://doi.org/10.1097/JOM.0000000000001427 

6.Rabin et al. 2018. https://doi.org/10.3389%2Ffpubh.2018.00102 

Poster 2  

Title: “Technology for Workplace Implementation of Solar Radiation Safety in Response to Climate Change” 

Presenter: Ms. Mary Buller, Klein Buendel 

Ms. Mary Buller

The sun’s energy is both life-saving and life-threatening. Americans who work outdoors are exposed to rising temperatures and extreme levels of ultraviolet radiation from the sun. These exposures, without preventive measures, can cause heat illness, skin cancer, and death. It is estimated that solar radiation contributed to over 350,000 deaths from excessive heat in 2019 and over 120,000 deaths from skin cancer in 2020. The U.S. government recently launched an interagency effort to combat extreme heat, including for persons who work outdoors, and the Surgeon General has identified occupational sun safety as part of a national priority for skin cancer prevention. 

Workplace interviews, a review of literature and existing programs, and expert consultants helped increase dissemination potential by expanding an intervention for occupational skin cancer prevention to include heat illness prevention. Content consultants included safety training professionals, behavioral scientists, and dermatologists. The program, Go Sun Smart at Work, also includes messaging for outdoor workers of all skin types and risk profiles for both heat illness and skin cancer to be delivered online through workplace learning management systems to improve its dissemination. It will be evaluated in 2024 in a randomized controlled trial enrolling 20 worksites, their managers, and outdoor employees. 

A virtual learning environment (VLE) has been programmed to disseminate and guide the implementation of comprehensive sun exposure reduction to workplaces. The VLE is a web-based program with a content database, a media platform for trackable employee training (compliant with eLearning standards), and an innovative, automated decision support tool. The tool is a chat bot-like program that customizes advice on adopting workplace policy and implementing prevention procedures to management’s readiness to innovate on sun safety based on Diffusion of Innovations Theory.  

Solar radiation prevention is urgently needed to help outdoor workers adapt to a warming world. Employers have been adopting virtual training rapidly to improve accessibility, resource and learning efficiency, engagement and information retention, and fidelity and trackability. Improvements in dissemination, training, and practice, as facilitated by this VLE, can save employers time and money, improve employee health behaviors, and reduce solar-related adverse events at work.  

This research was supported by a grant (CA257778; Ms. Mary Buller, PI) from the National Cancer Institute. Coauthors on this poster presentation included Dr. Barbara Walkosz, Ms. Julia Berteletti, Mr. Brandon Herbeck, Ms. Irene Adjei, and Dr. David Buller from Klein Buendel.  

Collaborator Spotlight:
Ms. Tessa jolls

Collaborator Spotlight:
Ms. Tessa jolls

Tessa Jolls, Center for Media Literacy

Klein Buendel collaborator, Ms. Tessa Jolls, has been the President and CEO of the Center for Media Literacy (CML) in California since 1999. Currently, she is working with Dr. Barbara Walkosz, Senior Scientist at Klein Buendel, to lead a new research project funded by the Centers for Disease Control and Prevention (CE003635). The aim of the project is to update and translate Beyond Blame: Challenging Violence in the Media, an evidence-based media-literacy violence prevention curriculum for middle school students, formerly delivered in person, into an interactive technology-based platform.

Created by CML, Beyond Blame, is a theory-based curriculum that underwent a rigorous long-term evaluation, in the Los Angeles Unified School District. Violence prevention programs, including school-based education programs, are recommended to address youth violence. 

CML is an educational organization that provides leadership, public education, professional development and evidence-based educational resources nationally and internationally. CML is dedicated to promoting and supporting media literacy education as a framework for accessing, analyzing, evaluating, creating and participating with media content. CML helps citizens, especially the young, develop critical thinking and media production skills needed to live fully in the 21st century media culture.

Ms. Jolls’ primary focus at CML is demonstrating how media literacy works through school and community-based implementation programs. She actively contributes to the development of the media literacy field internationally through her speaking, writing and consulting, with curriculum development and research projects, and through publishing and disseminating new curricular and training materials.

Recent Honors and Awards

  • Received the Fulbright NATO Security Studies Award in Brussels in 2021.
  • Co-taught the first media literacy undergraduate course at the University of Latvia Faculty of Social Sciences in 2019.  
  • Served as a 2019 Fulbright Specialist for a two-week assignment in Bulgaria, where she conducted workshop trainings.
  • Invited to attend the Stanford Graduate School of Business Executive Education, WICT Senior Executive Summit in March 2018.  
  • Served on the International Steering Committee for UNESCO’s Global MIL Alliance, and as co-chair of the Digital and Media Literacy Working Group, organized through the Children and Screens Initiative; resulted in a Pediatrics paper recommending research and policy priorities for the field.  
  • Organized  the Commit 2 MediaLit! Campaign to recognize Media Literacy Week in 2016.  
  • Received the Global Media and Information Literacy Award, in recognition of her work in Media and Information Literacy and Intercultural Dialogue, from the UNESCO-initiated GAPMIL, in cooperation with the United Nations Alliance of Civilizations (UNAOC) in 2015.
  • Honored with the International Media Literacy Award by Gateway Media Literacy Partners in 2014.
  • Recognized with the Jesse McCanse Award for Individual Contribution to Media Literacy by the National Telemedia Council in 2013.  
Decreasing access to marijuana by alcohol-impaired customers

Decreasing access to marijuana by alcohol-impaired customers

Recreational marijuana markets appear to be contributing to morbidity and mortality due to polysubstance impaired driving and other harms by selling a social intoxicant (marijuana) to already intoxicated customers. Impairment increases when marijuana is combined with alcohol, making driving particularly risky and also contributing to other injuries and violence. In recreational marijuana markets, deterrence efforts to reduce impaired driving directed at drivers face challenges due to dispute over THC levels in per se laws and lack of valid field sobriety tests.

A team of researchers at Klein Buendel, the Pacific Institute for Research and Evaluation, and NORC at the University of Chicago, is launching a new 5-year research project to study an alternative prevention approach — decrease access to marijuana by alcohol-impaired customers. The goal of this study is to test the effectiveness of a policy and training intervention in the state-licensed recreational marijuana market in a Northwest State, where state law bans sales to apparently-intoxicated customers. It combines policy efforts by state regulators to increase deterrence of the state’s law and motivate store management to comply and training of store personnel in skills to recognize intoxication and refuse sales, using a responsible marijuana vendor online training developed by the research team.

Specific Aims

Aim 1: Conduct pseudo-intoxicated patron (PiP) assessments at state-licensed recreational marijuana stores in the state’s largest metropolitan area in Year 1.

Aim 2: Implement a policy and training (PT) intervention in Year 2 designed to increase compliance with the state law prohibiting sale of recreational marijuana products to apparently-intoxicated customers with a subsample of stores, assigned at random, that intends to: a) make owners/managers of recreational marijuana stores aware of the state’s law prohibiting sales of marijuana to apparently-intoxicated customers, b) increase their risk perception and motivation to comply with this law, and c) train store personnel in skills needed to recognize signs of intoxication in customers and refuse sales.

Aim 3: Compare PT intervention stores to usual and customary policy and training stores in a randomized controlled trial by posttesting state-licensed recreational marijuana stores in the large metro area with PiP assessments for refusal of sales in Year 3.

Aim 4: Estimate impact of the PT intervention on refusal to PiPs by implementing the PT intervention with the remaining stores in Year 3 in a partial cross-over design and assessing state-licensed stores with the PiP protocol in Year 4 and in Year 5.

The research is innovative and high impact by testing one of the first interventions to prevent recreational marijuana sales to apparently-intoxicated customers in one of the first states to ban such sales to reduce the risk of polysubstance impaired driving and other harms. The design allows for reproducibility by using a partial crossover. The PT intervention can be a model intervention to improve compliance with regulations on recreational marijuana sales in other states that have legalized recreational marijuana or that are considering legalization. 

The research is supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA031591). Dr. W. Gill Woodall and Dr. David Buller from Klein Buendel are the Project’s Multiple Principal Investigators. Dr. Robert Saltz from the Pacific Institute for Research and Evaluation and Mr. James Fell from NORC are collaborating Co-Investigators.

KB Investigators Present at EUSPR

KB Investigators Present at EUSPR

Three Klein Buendel Principal Investigators gave presentations on their recent or active research projects at the 14th European Society for Prevention Research Conference held October 4-6, 2023 in Sarajevo, Bosnia and Herzegovina. The presenters were Dr. David Buller, Director of Research, Dr. Barbara Walkosz, Senior Scientist, and Ms. Mary Buller, President. Each presentation complemented the conference theme of “Optimizing Prevention Infrastructures.” The prevention interventions were implemented in workplaces to reach their target populations directly and impactfully.   

Presentation 1

Dr. David Buller

“Formative Research on Professional Development Training to Maintain Responsible Beverage Service Practices”

Improved interventions are needed to reduce the negative consequences of alcohol intoxication. Responsible beverage service (RBS) training has been effective at reducing service to intoxicated customers in some cases. Its efficacy might be improved with an intervention that supports RBS techniques in the years between government-required RBS retraining. We conducted formative research to develop an ongoing professional development component for an online RBS training.

Formative research explored feasibility, acceptability, and content for an ongoing professional development intervention for alcohol servers. Semi-structured interviews were performed with owners/managers of licensed establishments (n=10) and focus groups (n=19) and survey (n=24) with alcohol servers in New Mexico and Washington. A prototype of a professional development component was produced, covering advanced RBS skills, support from experienced servers, professionalism, and basic management training, for delivery through social media. It was evaluated in a usability survey with alcohol servers (n=20) in California, New Mexico, and Washington.

While owners, managers, and alcohol servers were favorable toward RBS in their establishments, they endorsed the need for ongoing support for RBS for servers. Among topics of high interest were sharing tips, methods, and stories from experienced servers, balancing pressure to sell, navigating adult-use marijuana laws, dealing with children, recognizing intoxication, and managing difficult customers. The prototype was comprised of 50 social media posts, including text, infographics, videos, and interactive activity. Servers rated it as highly usable and appropriate for themselves and the establishment. Most servers (70%) were interested in receiving the ongoing information and activities.

Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed establishments. Servers were interested in using such program. The professional development component has the potential to improve an existing RBS intervention.

Collaborators on this presentation included Dr. David Buller and Dr. W. Gill Woodall from Klein Buendel, and Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation in California. This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA029364; W. G. Woodall and D. Buller, MPIs).

Presentation 2

Dr. Barbara Walkosz

“Sun Safety Ink!: Sun Safety Practices of Tattoo Studio Clients”

Melanoma is the second most common cancer among young adults in the United States. Sunburn prevalence and low rates of sun protection are elevated in this group. Thus, efforts are needed to promote skin cancer prevention. An estimated 225 million people worldwide have tattoos with 40% of adults ages 18-29 with at least one tattoo, and at least 30% of American have tattooed skin. Sun Safety Ink! is a skin cancer prevention program targeted to clients of tattoo studios The goal of Sun Safety Ink! is to promote full-body comprehensive sun protection to clients of tattoo studios to compliment standard aftercare instructions that recommend sun protection for new tattoos.

Thirty-seven tattoo studios were enrolled in the Sun Safety Ink! program. At pretest, clients were recruited by tattoo artists to complete an online survey that assessed current self-reported sun protection (sunscreen, lip balm, hats, protective clothing, sunglasses, and shade), number of sunburns, and sunbed tanning frequency in the last year. Respondents were also asked to locate the position of tattoos on their body, using a drawing tool. 

A total of 861 clients completed the online survey. Respondent demographics: age, average 31 yrs.; 67% female, 30% male; 60% white, 27% more than one race, 2% African American, 1% Asian and Native American, 13% Hispanic/Latino. The most prominent tattoo locations included: front left arm, 66%, front right arm, 58%, front upper torso, 52%, and back upper torso, 48%. Sun safety practices, that is, full body sun protection, (on a 5-point scale of “always” to “never”) were reported as: apply sunscreen SPF 15+ on face (aftershave, face lotion, or make-up), 3.31; apply sunscreen SPF 30+ on all exposed skin areas, 3.22; reapply sunscreen, 3.08; apply a lip balm, 3.28; wear any hat, 2.91; wear wide-brimmed hat, 2.21; wear sunglasses, 3.89; stay mostly in the shade, 3.38; and wear protective clothing, 2.91. Respondents also reported the number of sunburns as 1.53 and number of times indoor tanning as 1.11 in the last 12 months.

The pretest results indicate that full-body sun safety practices of tattooed adult can benefit from improvement, particularly wearing of hats and sun protective clothing. Further, knowledge of tattoo locations can direct sun safety recommendations to include protecting not only tattoos on arms and torsos but also non-tattooed skin on those areas of the body. Tattoo studies may be a viable location to delivering effective sun safety interventions to hard-to-reach tattooed, young adults.

Collaborators on this presentation included Dr. Barbara Walkosz, Ms. Mary Buller, and Dr. David Buller from Klein Buendel, and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the Department of Veteran Affairs. This research was supported by a grant (CA206569; B. Walkosz, PI) from the National Cancer Institute.

Presentation 3

Ms. Mary Buller

“Protection from Solar Radiation in the Era of Climate Change: Preventing Heat Illness and Skin Cancer for Outdoor Workers”

The sun’s energy is both a necessity and a threat to humans. Extreme heat linked to climate change and unprotected exposure to ultraviolet radiation (UV) make people who work outdoors vulnerable to life-threatening heat illness and skin cancer. It is estimated that infrared radiation (heat) and UV contributed to over 120,000 deaths from skin cancer in 2020 and over 350,000 deaths from excessive heat in 2019. Efforts to protect workers from heat or UV can work in tandem to help outdoor workers adapt to the warming world.

Workplace interviews, a review of literature, and expert consultants helped expand an existing intervention for U.S. occupational skin cancer prevention to include heat illness prevention, and to be delivered online. Content consultants include safety training professionals, behavioral scientists, and dermatologists. The program, Go Sun Smart at Work (GSSW), will be evaluated in 2024 in a randomized controlled trial enrolling 20 U.S. employers.

GSSW is an innovative virtual learning environment and resource hub promoting comprehensive solar radiation policy, training, and personal protection for outdoor workers. It includes (1) a manager resource hub that guides decision-makers through implementation strategies using a structured conversation agent; (2) an employee sun safety training video that is compliant with eLearning standards and compatible with learning management systems for monitoring; and (3) a trove of resources and downloadable materials addressing heat illness and skin cancer prevention. The structured conversational agent adjusts workplace implementation strategies for management’s readiness to innovate on sun safety based on Diffusion of Innovations Theory.

GSSW will help outdoor workers protect themselves from the serious threats of climate change by providing employers with a convenient, comprehensive solar radiation safety policy and training program. It will support the shift to online training to improve accessibility, fidelity, adherence, and tracking, while saving resources.

Collaborators on this presentation included Ms. Mary Buller, Dr. Barbara Walkosz, Ms. Julia Berteletti, Mr. Brandon Herbeck, Ms. Irene Adjei, and Dr. David Buller from Klein Buendel. This research was supported by a grant (CA257778; M. Buller, PI) from the National Cancer Institute.

Custody & Caring Conference

Custody & Caring Conference

A research team from Penn State University and Klein Buendel gave three presentations on their recent work related to the care of persons aging and dying in prison at the 18th Biennial International Conference on the Nurse’s Role in the Criminal Justice System. The Custody & Caring Conference was held in Saskatoon, SK, Canada on September 20-23, 2023.

Podium Presentation and Poster 1

“Small-Scale Usability Testing: E-learning Modules for Peer Caregivers”

Growing numbers of people globally will grow old and die while incarcerated. Research evidence supports using peer caregivers to assist staff with geriatric and end-of-life care. Currently, peer caregiver training varies widely in content and duration. Evidenced-based, accessible, and contextually relevant materials are needed to effectively prepare the caregivers. This study’s purpose was to conduct research and development of Just Care, a six-module e-learning program for peer caregivers and a single module to guide corrections staff in implementing the program. University IRB, U.S. Department of Health & Human Services, and Department of Corrections permissions were obtained, and participants signed informed consent. Deputy Wardens assisted in identifying people meeting our inclusion criteria. Nineteen people living in prison and 11 staff took part in the usability testing of the progam. Researchers directed participants to share their thoughts aloud. Field notes were taken. Participants completed six open-ended questions and the System Usability Scale (SUS).

Findings focused on functionality, design, and content of Just Care. All users easily navigated through the program with minimal guidance. Many noted Just Care’s utility for future peer caregivers. Challenges faced were clustered by level of severity from 1-3 (1=most; 3=least severe). There were no severity-level 1 issues in either round. In Round 1, Just Care received a SUS score of 87.5 by incarcerated users and 74.5 by staff. A SUS score of 68 is an above average score. Following rapid refinement, Round 2 incarcerated participants scored Just Care at 85.28 while staff scored it at 83.75. Some incarcerated users had difficulty navigating the post-test assessments in Round 2. A few staff users noted liking the additional resources available via links to PDFs. One staff user voiced concern about the safety of having incarcerated people help with care. Overall, participants found Just Care easy to navigate with interactive content that is very useful, engaging, and relevant to providing geriatric and end-of-life care in prisons. Staff also noted that Just Care raised awareness about the growing need for programming on geriatric care in prisons and that a peer caregiver program like Just Care is a viable solution that is implementable by prison staff.  

Poster 2

“Determining Priority Dementia Care Training Needs for Correctional Staff and Peer Caregivers”

People aged 50 and older in prisons are at particular risk for developing Alzheimer’s Disease and Related Dementias (ADRD) due to several social determinants of health. The number of patients in prison with ADRD is not known. This situation can likely be attributed to many corrections health, social, and security staff lacking the requisite skills for identifying ADRD. Dementia care inequities between prisons and community settings need to be addressed. A standardized, feasible, and acceptable ADRD education program developed for those caring for and/or managing people who are incarcerated and living with ADRD is a pressing need.

The key purpose of the research was to identify three priority learning needs of multidisciplinary prison staff to provide enhanced management and care for people living with ADRD in prisons which also represented the critical learning needs of peer caregivers so that they may assist staff with ADRD care. The study also sought to identify a logo to brand the new Just Care for Dementia training. The third outcome was to translate best practices from community-based ADRD care into accessible and relevant content for training staff and peer caregivers that is evidence-based and can be programmed into highly interactive prototype e-learning modules that fit within the restrictive context of corrections. Focus group methodology facilitated potential future users input to aid us in ensuring the content, design, and technology plans match the needs and constraints of prison. Approvals were secured from the: Institutional Review Board; federal government; and Department of Corrections. Participants provided signed informed consent. The settings were one men’s and one women’s state prison in the United States. Twelve interdisciplinary staff and 11 peer caregivers participated.

Thematic analyses revealed three priority content areas: fostering a safe and calm environment; addressing behavioral and psychological symptoms of dementia; and enhancing awareness of need. Insights on nine showcased logos revealed two clear preferences. Consultation with the study’s advisory board informed final logo selection for branding the Just Care for Dementia e-learning product. In conclusion, participants confirmed the need for a such a training program and indicated this is a viable approach to addressing a pressing training and related care need in prisons.

This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging [AG057239; Dr. Susan Loeb (Penn State) and Dr. Barbara Walkosz (Klein Buendel), Multiple Principal Investigators]. Collaborators on the presentation and posters also included Dr. Erin Kitt-Lewis, Mr. Sherif Olanrewaju, and Ms. Katherine Aiken from The Penn State University; and Mr. Brandon Herbeck, Ms. Amanda Brice, and Mr. Steve Fullmer from Klein Buendel.  

Challenging Violence in the Media

Challenging Violence in the Media

Klein Buendel and the Center for Media Literacy in California are launching a new research project to update and translate Beyond Blame: Challenging Violence in the Media, an evidence-based media-literacy violence prevention curriculum for middle school students, formerly delivered in person, into an interactive technology-based platform. Beyond Blame, developed by the Center for Media Literacy,is a theory-based curriculum that underwent a rigorous long-term evaluation, in the Los Angeles Unified School District. Violence prevention programs, including school-based education programs, are recommended to address youth violence.

According to the Centers for Disease Control and Prevention (CDC), “youth violence is a serious public health problem and that an adverse childhood experience can have a long-term impact on health and well-being, disproportionately impacting communities of color.” Violence affects thousands of youths each day as well as their families, schools, and communities. CDC reports that youth can be involved in violence as a victim, offender, or witness. Homicide is the third leading cause of death for young people ages 10-24 and the leading cause of death for non-Hispanic Black or African American youth.1,2 However, youth violence is preventable and the development of evidence-based approaches that address the factors to decrease the risk of violence, buffer against that risk, and promote positive youth development and well-being3 are imperative.  

A number of factors exist that may increase or decrease the possibility of youth experiencing or enacting violence. Media violence has long been identified by public health as a risk factor and violent content in television, social media, and video games has been associated with aggression and youth violence. Yet, media literacy programs are often not included in violence prevention efforts. Media literacy is recognized as a life skill to strengthen and provide resiliency for an individual’s ability to resist negative and harmful messages that are powerfully packaged and promoted in the media.

Today, youth live in an unprecedented mediated environment. With technology allowing 24-hour media access, the amount of time youth spend with media has risen dramatically, especially among minority youth. This is evidenced by widespread media usage by middle school children: 98% watch television, 78% use tablets, 67% interact with smart phones, 73% use computers, and 68% use gaming devices. Children ages 8-12 in the U.S. average 4-6 hours a day watching or using screens. To help children navigate this mediated environment, media literacy education provides a framework to access, analyze, evaluate, create and participate using media in a variety of forms, including videos, social media (such as TikTok and You Tube), video games, film, and television.  

Upon completing Beyond Blame in person, students significantly increased their knowledge of the Five Core Concepts/Key Questions of media literacy, increased recognition of their exposure to media violence, and had stronger beliefs that media violence affects users. The original Beyond Blame aligns with the Common Core standards identified for Language Arts, and the technology-based curriculum will adhere to the same standards along with the International Society for Technology in Education Standards that ensure that using technology for learning can create high-impact, sustainable, scalable, and equitable learning experiences for all learners. 

This research is supported by a grant from the CDC (CE003635). The project team will be led by Multiple Principal Investigators, Dr. Barbara Walkosz, a Senior Scientist at Klein Buendel, and Ms. Tessa Jolls, President of the Center for Media Literacy and will be joined by a Co-Investigator, Dr. Christine Rizzo from Northeastern University in Massachusetts. The Klein Buendel Creative Team will design and program the Beyond Blame prototype. 

References

  1. David-Ferdon C, Clayton HB, Dahlberg LL, et al. Vital signs: Prevalence of multiple forms of violence and increased health risk behaviors and conditions among youths – United States, 2019. MMWR Morb Mortal Wkly Rep. 2021;70(5):167-173. doi: 10.15585/mmwr.mm7005a4.PMC7861486  
  2. Sheats KJ, Irving SM, Mercy JA, et al. Violence-related disparities experienced by black youth and young adults: opportunities for prevention. Am J Prev Med. 2018;55(4):462-469. doi: 10.1016/j.amepre.2018.05.017.PMC6691967 
  3. youth.gov. Youth topics: violence prevention. Interagency Working Group on Youth Programs. Available at: https://youth.gov/youth-topics/violence-prevention. Accessed March 28, 2022. 
Introducing Way To Serve Español!

Introducing Way To Serve Español!

WayToServe®, an evidence-based online responsible alcohol server training program, has been launched in Spanish in California – as Way To Serve Español – to meet the needs of Spanish-speakers in the food and beverage industry.

Responsible Beverage Service (RBS) training has shown promise to reduce alcohol-related injury and mortality. WayToServe was created by scientists and developers from the University of New Mexico, the Pacific Institute for Research and Evaluation, and Klein Buendel. The engaging, media-rich program was initially evaluated in a randomized controlled trial that resulted in high trainee satisfaction and increased refusal of sales to intoxicated patrons. WayToServe was licensed to Wedge Communications LLC and launched into the online marketplace in 2012. To date, WayToServe has been expanded and approved for sale and certification of trainers in New Mexico, California, Texas, and Washington. Wedge Communications will distribute Way To Serve Español, as well.

The original WayToServe project was sponsored by two grants from National Institute on Alcohol Abuse and Alcoholism to the University of New Mexico (AA014982 and AA016606; Dr. W. Gill Woodall, Principal Investigator). The subsequent WayToServe Español project was sponsored by a grant from the National Institute of Minority Health and Health Disparities (MD010405; Dr. W. Gill Woodall, Klein Buendel Senior Scientist, Principal Investigator). Collaborators included Dr. Robert Saltz from the Pacific Institute for Research and Evaluation; Dr. Frank Perez and Dr. Areli Chacon Silva from the University of Texas at El Paso; Dr. Victoria Sanchez and Dr. Randall Starling from the University of New Mexico; Dr. David Buller, Ms. Jeanny Camacho Reither, Ms. Lila Martinez, and Ms. Marita Brooks from Klein Buendel.