A Year of Research and Outreach

A Year of Research and Outreach

This was a very productive year for Klein Buendel (KB). In 2018, our scientists and staff:

  • Competed successfully for 4 new prime grant and subcontract research awards;
  • Completed 7 prime and subcontract research projects;
  • Presented research findings at 17 local, national, and international conferences and expert meetings; a total of 34 presentations, panel discussions, and posters; and
  • Published 20 research manuscripts in peer-reviewed journals.

It was also a very exciting year because KB was one of three North American sponsors and organizers of the 4th International Conference on UV and Skin Cancer Prevention. KB co-sponsored the conference with Ryerson University in Toronto, Ontario, Canada and the Canadian Dermatology Society. The conference was held in Toronto on May 1-4, 2018.

And KB celebrated it’s Sweet 16th Birthday in June!

Additional highlights of our 2018 research publications, conference presentations, and outreach activities are listed below. Publications may include manuscripts that were in press or published in electronic format last year. The names of KB investigators and staff are bolded.

Publications

Loeb SJ, Penrod J, Myers VH, Baney BL, Strickfaden SM, Kitt-Lewis E, Wion RK. Enhancing Care of Aged and Dying Prisoners: Is e-Learning a Feasible Approach? J Forensic Nurs. 2017 Dec;13(4):178-185.

Cochrane SK, Chen SH, Fitzgerald JD, Dodson JA, Fielding RA, King AC, McDermott MM, Manini TM, Marsh AP, Newman AB, Pahor M, Tudor-Locke C, Ambrosius WT, Buford TW; LIFE Study Research Group. Association of Accelerometry-Measured Physical Activity and Cardiovascular Events in Mobility-Limited Older Adults: The LIFE (Lifestyle Interventions and Independence for Elders) Study. J Am Heart Assoc. 2017 Dec 2;6(12).

Wang-Schweig M, Miller BA, Buller DB, Byrnes HF, Bourdeau B, Rogers V. Using panel vendors for recruitment into a web-based family prevention program: methodological consideration. Evaluation and the Health Professions. 2017 Jan 1: 163278717742189. doi: 10.1177/0163278717742189. [Epub ahead of print]

Berteletti J, Buller DB, Massie K, Ashley J, Liu X, & Reynolds, KR. Sun protection policies in public school districts with elementary schools in California. JAMA Dermatol. 2018 Jan 1;154(1):103-105.

Buller DB, Reynolds KD, Berteletti J, Massie K, Ashley J, Buller MK, Meenan RT. Accuracy of principal and teacher knowledge of school district policies on sun protection in California elementary schools. Prev Chronic Dis. 2018 Jan 18;15:E07. doi: 10.5888/pcd15.170342.

Gellar AC, Jablonski NG, Pagoto SL, Hay JL, Hillhouse J, Buller DB, Kenney L, Robinson JK, Weller RB, Moreno MA, Gilchrest BA, Sinclair C, Arndt J, Taber JM, Morris KL, Dwyer LA, Perna FM, Klein WMP, Suls J. Interdisciplinary perspectives on sun safety. JAMA Derm. 2018; 154(1):88-92.

Buller DB, Heckman CJ, Manne SL. The potential of behavioral counseling to prevent skin cancer. JAMA Dermatol. 2018 May;154(5):516-521.

Buller DB, Walkosz BJ, Buller MK, Wallis A, Andersen PA, Scott MD, Eye R, Liu X, & Cutter GR. Results of a randomized trial on an intervention promoting adoption of occupational sun protection policies. Am J of Health Promot. 2018 May;32(4):1042-1053.

Hay JL, Zielaskowski K, White KM, Kaphingst K, Robers E, Guest D, Sussman A, Talamantes Y, Schwartz M, Rodriguez VM, Li Y, Schofield E, Bigney J, Hunley K, Buller D, Berwick M. Interest and uptake of MC1R testing for melanoma risk in a diverse primary care population: a randomized clinical trial. JAMA Dermatol. 2018 Jun 1;154(6):684-693.

Walkosz BJ, Buller D, Buller M, Wallis A, Meenan R, Cutter G, Anderson P, Scott M. Sun Safe Workplaces: effects of an occupational skin cancer prevention program in employee sun safety practices. J Occup Environ Med. 2018 Nov;60(11):900-997.

Buller DB, Woodall WG, Saltz R, Grayson A, Buller MK. Implementation and Effectiveness of an Online Responsible Vendor Training for Recreational Marijuana Stores in Colorado, Oregon, and Washington State. J Public Health Manag Pract. 2018 Aug 31. [Epub ahead of print]

Nostrati A, Pimentel MA, Falzone A, Hegde R, Goel S, Chren M, Eye R, Linos E, Pagoto S, Walkosz BJ. Skin cancer prevention messages on Facebook: likes, shares and comments. J Am Acad Dermatol. 2018 Sep;79(3):582-585.

Kasting ML, Christy SM, Sutton SK, Lake P, Malo TL, Roetzheim RG, Schechtman T, Zimet GD, Walkosz BJ, Salmon D, Kahn JA, Giuliano AR, Vadaparampil ST. Florida Physicians’ Reported use of AFIX-Based Strategies for Human Papillomavirus Vaccination. Prev Med. 2018 Sep 13. pii: S0091-7435(18)30282-2. doi: 10.1016/j.ypmed.2018.09.004. [Epub ahead of print]

Buller MK, Andersen P, Bettinghaus EP, Liu X, Slater MD, Henry K, Fluharty L, Fullmer S, Buller DB. Randomized Trial Evaluating Targeted Photographic Health Communication Messages in Three Stigmatized Populations: Physically-disabled, Senior, and Overweight/Obese Individuals. Journal of Health Communication. 2018;23(10-11):886-898.

Woodall WG, Starling R, Saltz RF, Buller DB, Stanghetta P. Results of a randomized trial of web-based retail onsite responsible beverage service training: Waytoserve.org. Journal of Studies on Alcohol and Drugs. 2018 Sept;79(5):672-679.

Woodall WG, Starling R, Saltz RF, Buller DB, Stanghetta P. Responses to Commentaries by Miller (2018) and Buvik and Rossow (2018). J Stud Alcohol Drugs. 2018 Sep;79(5):684-685.

Buller DB, Walkosz BJ, Buller MK, Wallis A, Andersen PA, Scott MD, Meenan RT, Cutter GR. Implementation of occupational sun safety at a two-year follow-up in a randomized trial: comparison of sun safe workplaces policy intervention to attention control. American Journal of Health Promotion. 2018 Nov 26:890117118814398. doi: 10.1177/0890117118814398. [Epub ahead of print]

Kitt-Lewis E, Loeb SJ, Myers VH, Wion RK, Baney B, Strickfaden S. Developing training to enhance care of aged and dying inmates: set-up phase. Public Health Nursing. In press.

Byrnes HF, Miller BA, Grube JW, Bourdeau B, Buller DB, Wang-Schweig M, Woodall WG. Prevention of alcohol use in older teens: A randomized trial of an online family prevention program. Psychology of Addictive Behaviors. In press.

Buller MK, Bettinghaus EP, Fluharty L, Andersen PA, Slater MD, Henry KL, Liu X, Fullmer S, Buller DB. Improving health communication with photographic images that increase identification in three minority populations. Health Ed Res. In press.

Conference Presentations

NASPA Well-being and Health Promotion Leadership Conference — January 18-20 in Portland, Oregon
• Myers VH, Newton RL, Jerrod T. Healthy Detours: A location-based services app to promote healthy choices among college students. (presentation)

University of Alabama Birmingham School of Medicine Center for Exercise Medicine’s Distinguished Lecture Series — March 13 in Birmingham, Alabama
• Myers V. Caminemos Juntas: A Location-Based Smartphone App for Latinas to Connect with Nearby Walking Partners. (presentation)

Eastern Nursing Research Society Annual Meeting — April 11-13 in Newark, New Jersey
• Loeb SJ, Kitt-Lewis E, Myers VH. Development of Computer-based Training for Inmate Caregivers through Nursing Science and Technological Innovations. (presentation)

Society of Behavioral Medicine Annual Meeting — April 11-14 in New Orleans, Louisiana
• Berteletti J, Strickfaden S, Woodall WG, Starling R, Zimet G, Stupiansky N, Chilton L. BeVaccinated: Designing a web app to promote teen vaccination uptake. (poster)
• Buller D, Walkosz B, Buller MK, Wallis A, Meenan R, Liu X. Moderators of implementation of occupational sun protection policy by public-sector employers in a randomized trial. (presentation)
• Goldstein C, Alshurafa N, Spruijt-Metz D, Thomas G, Jake Schoffman D, Goldstein S, Wac K, Myers V. The Digital Health Council & ETCD present perspectives on effective digital health training in behavioral medicine. (panel discussion)
• Jackson J, Castro Sweet C, Coa K, Foster G, Matacotta J, Myers V, Place S, Keefe B, Osborn C, Wolin K. Speed networking your career options: Non-academic paths for behavior scientists. (panel discussion)
• McLeod D, Myers V, Stetson B, Sheean P. Nuts and Bolts: A practical Q&A about your education and career trajectory. (panel discussion)
• Myers V, Loeb SJ, Kitt-Lewis E, Jerrod T, Strickfaden S, Wion RK. What works in corrections: Front-line insights on computer-based training. (poster)
• Myers VH, Hudson H, Jerrod T, Strickfaden S, Buller M, Lippert M. Pinpoint: Gaming technology to engage adolescent sickle cell patients in precision pain management. (poster)
• Pagoto S, Berteletti J, Walkosz B, Oleski J, Palumbo A, Baker K, Hillhouse J, Henry K, Buller D. Delivering health promotion interventions on social media: Engagement and methodological considerations. (panel discussion)
• Reynolds K, Buller D, Berteletti J, Massie K, Ashley J, Buller MK, Meenan R. Correlates of sun safe policy implementation among elementary schools. (poster)
• Newton RL, Myers V, Carter L, Griffith D. A Mobile Phone-based physical activity maintenance app for African American men: MobileMen. (presentation)

Patient Centered Outcomes Research 8th Annual Symposium – April 24-25 2018 in St. Louis, Missouri
• Buller DB. Precision Skin Cancer Prevention: A Sun Safety Mobile App. (presentation)

4th International Conference on UV and Skin Cancer Prevention – May 1-4, 2018 in Toronto, Ontario, Canada
• Buller D. A Facebook Intervention to Reduce mothers’ Permissiveness for Indoor Tanning: Health Chat. (presentation)
• Meenan RT, Buller DB, Reynolds KD, Massie K, Berteletti J, Buller MK, Ashley J. Costs of Sun Protection Policy Implementation in California School Districts. (presentation)
• Meenan R, Buller D, Walkosz B, Eye R, Buller M, Wallis A. Estimated Cost of Occupational Sun Protection Policy Intervention Delivery to Public-Sector Employers. (presentation)
• Massie K, Berteletti J, Freeth B, Ashley J, Buller MK, Buller DB, Reynolds KD. Implementation Strategies: Review of a Sun Safety Program in California. (poster)
• Walkosz B, Dellavalle R, Buller M, Buller D, Eye R, Olivas S. Formative Research to Develop Sun Safety Ink!, a Skin Cancer Prevention Training Program for Tattoo Artists. (presentation)

International Communication Association Annual Meeting — May 24-28 in Prague, Czech Republic
• Woodall WG, Berteletti J, Starling R, Zimet G, Stupainsky N, Kong A, Chilton L. Usability testing of a web app to improve adolescent vaccination: Be Vaccinated. (presentation)
• Walkosz B, Buller D, Buller MK, Wallis A, Meenan R, Scott M, Andersen P, Cutter G. Sun Safe Workplaces: Effect of a communication theory-based occupational skin cancer prevention program on employee sun safety practices. (presentation)

UNESCO International Conference on the Tangible and Intangible Impact of Information and Communication in the Digital Age — June 4-8 in Khanty-Mansiysk, Russia
• Walkosz B. Emerging Issues in Media Literacy in the 21st Century. (presentation)

National Cancer Institute Cancer Center HPV Vaccination Meeting – June 7-8 in Washington, DC
• Kong A, Woodall WG, Zimet G, Reither J, Myers V, Buller D, Starling R, Chilton L, Ginossar T. Improving HPV Vaccine Uptake with Digital Interventions. (presentation)

National Research Society on Alcoholism Annual Scientific Meeting – June 16-20 in San Diego, California
• Sanchez V, Chacon A, Perez F, Reither J. WayToServe-Español: Adapting an Evidence-Based Online Responsible Beverage Server (RBS) Training for Spanish Language Populations in the US Southwest. (poster)

National Cancer Institute Exercise Science and Skin Cancer Prevention Research Meeting — September 26-27 in Washington, DC
• Buller D, Walkosz B. Translational Research in Sun Safety in Sports Settings. (presentation)

National Commission on Correctional Health Care Conference – October 12-16 in Fort Lauderdale, Florida
• Loeb S, Myers V, Kitt-Lewis E. Developing and Testing E-Training to Enhance Care of Aged and Dying Prisoners. (poster)

EUSPR Conference and Members’ Meeting – October 24-29 in Lisbon, Portugal
• Miller BA, Rogers V, Byrnes H, Johnson M, Buller DB, Grube J, Berteletti J. Influences of Personal Characteristics on Group-based Club Intervention Outcomes. (presentation)

Colorado Cancer Coalition Annual Symposium — November 8-9 in Lakewood, Colorado
• Myers V. Caminemos Juntas: Using Technology and Social Media to Advance Your Mission. (presentation)

American Public Health Association Annual Meeting — November 10-14 in San Diego, California
• Buller DB, Woodall WG, Saltz R, Grayson A, Buller MK, Svendsen S. Implementation and Effectiveness of an Online Responsible Vendor Training for Recreational Marijuana Stores in Colorado, Oregon, and Washington State. (presentation)

EUROGIN International Multidisciplinary HPV Congress – December 2-5 in Lisbon, Portugal
• Woodall WG. Digital Interventions to Improve HPV Vaccine Uptake: Results and Issues. (presentation)
• Woodall WG, Zimet G, Reither J, Kong A, Buller DB, Chilton L, Myers V, Starling R, Ginossar T. Vacteens: Results from Ongoing Trials of Mobile Web Apps to Improve HPV Vaccine Uptake. (poster)
• Buller DB, Walkosz B, Berteletti J, Pagoto S, Oleski J, Baker K. Insights on HPV Vaccination from Mothers’ Comments on Facebook Posts in a Randomized Trial. (poster)

The Science of Dissemination & Implementation in Health Annual Conference – December 3-5 in Washington, DC
• Meenan R, Reynolds K, Buller D, Massie K, Berteletti J, Buller MK, Ashley J. Economic evaluation of a sun protection promotion program in California elementary schools. (presentation)
• Loeb S, Myers V, Kitt-Lewis E, Wion RK, Jerrod T, Carter M. Developing Geriatric and End-of-Life E-training For Inmate Peer Caregivers (poster)

Other Highlights & Recognitions

In February, Dr. Valerie Myers, began her tenure as a mentor for the SPRINT program at the National Cancer Institute. She also began serving as a mentor on Dr. Seth Creasy’s K Award entitled, “Linking Temporal Pattern of Modifiable Behaviors to Weight Loss Outcomes”.

Dr. David Buller was a co-author on a chapter in a book that was selected as the 2018 recipient of the Gerald R. Miller Boo Award for Interpersonal Communication from the National Communication Association:

    The book is: D.O. Braithwaite and P. Schrodt (Eds.), Engaging theories in interpersonal communication: Multiple perspectives, 2nd edition (pp. 343-356). Thousand Oaks, CA: Sage.
    The chapter is: Burgoon, J. K., & Buller, D. B. (2015). Interpersonal deception theory: Purposive and interdependent behavior during deceptive interpersonal communication.

Dr. Susan Loeb and Dr. Valerie Myers’ Phase I STTR Project, E-training of Inmate Peer Caregivers for Enhancing Geriatric and End-of-Life Care in Prisons, was selected for inclusion in the NIH Niche Assessment Program for small businesses.

KB received trademark registration through the U.S. Patent and Trademark Office for Train To Tend®.

Way To Serve®, the licensed evidence-based online responsible alcohol server training program owned by KB and its research collaborators, achieved a significant milestone by selling 75,000 trainings since it entered the market.

KB, along with Rocky Mountain Sunscreen and the Colorado Skin Cancer Task Force, offered free UV camera photographs and skin cancer prevention education to attendees at the Snowsports Industries of America Snow Show in January and the Outdoor Retailer Summer Market in July. Both trade shows were held at the Colorado Convention Center in Denver, Colorado.

Beginning in September, KB made its Grade K-5 sun safety curriculum, Sunny Days Healthy Ways®, available free to the public in response to the Surgeon General’s Call to Action to Prevent Skin Cancer.

KB was recognized on Colorado Biz Magazine’s Top 100 Woman-Owned Companies list. KB landed at #48 for 2018. Colorado Biz Magazine ranked Klein Buendel #142 of Top 250 Private Companies for 2018.

Here’s to a Very Healthy and Happy New Year!

Cost Analysis of a Sun Safety Program at California Elementary Schools

Cost Analysis of a Sun Safety Program at California Elementary Schools

The Surgeon General’s 2014 Call to Action to Prevent Skin Cancer emphasized the importance of sun safety for schools. However, limited cost data exist to inform implementation decisions regarding school sun safety practices. In response, Dr. Richard Meenan from the Kaiser Permanente Center for Health Research (KPCHR), presented data on the costs of delivering a sun protection policy intervention to public elementary schools in California at the 11th Annual Conference on the Science of Dissemination and Implementation in Health in Washington DC, December 3-5, 2018.

The Sun Safe Schools (SSS) program, a joint research effort of Claremont Graduate University (CGU), KPCHR, and Klein Buendel (KB), provided technical assistance to California public elementary schools interested in implementing sun safety practices consistent with their district board policy for sun safety. The research design included a randomized trial of SSS that assessed its effectiveness in promoting implementation and an economic evaluation of the SSS program.

Fifty-eight intervention schools and 60 controls participated. Principals at intervention schools received regular phone and email contact from trained SSS coaches over 20 months to support implementation of selected sun safety practices. Rolling recruitment and intervention occurred over 47 months (2014-18). Study outcome data are from a posttest survey of school principals. Intervention delivery costs were virtually all labor (SSS coach and principal time). Implemented practices were organized into ten categories (such as student education and outdoor shade) and micro-costed using a project-developed template. Required school labor and non-labor resources for implementation were estimated for each practice. Three elementary school principal consultants reviewed the template for appropriateness.

Intervention delivery costs and costs of implemented practices for intervention schools and control schools were presented and are being submitted for publication. Principals’ beliefs about the importance of sun protection were positively correlated with policy implementation, both in numbers of implemented policies and overall dollars invested. Results indicated that a low-cost program of regular phone and email coaching of school administrators can successfully stimulate implementation of sun safety practices in elementary schools at a reasonable cost. Costs per student were similar to other school health practices. These findings can assist administrators with selecting and implementing appropriate sun safety practices for their schools.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (HD074416; Dr. Kim Reynolds, Claremont Graduate University, Principal Investigator). Collaborators in addition to Dr. Reynolds and Dr. Meenan include Kim Massie from Claremont Graduate University in California; Dr. David Buller, Julia Berteletti, and Mary Buller from Klein Buendel; and Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California.

Vacteens: A Mobile Web App to Improve HPV Vaccine Uptake

Vacteens: A Mobile Web App to Improve HPV Vaccine Uptake

Dr. W. Gill Woodall from Klein Buendel (KB) and the University of New Mexico and Jeanny Reither from KB presented findings from the Vacteens Project at the Eurogin International Multidisciplinary HPV Congress in Lisbon, Portugal, December 2-5, 2018. Eurogin is one of the most important conferences on Human Papillomavirus (HPV) infection and related cancers. It aims to raise the public health profile of HPV, increase the need for responsible health services, and examine the cost-effectiveness of risk-based screening to pave the way for the development of new strategies for the prevention of HPV-induced cancers.

The uptake of the HPV vaccine in the United States remains significantly below the Healthy People 2020 goal of 80% series completion, and this is particularly so for the young adolescent age range, when the immunogenic response to the vaccine is stronger. While a number of factors may account for this less than desirable vaccine uptake, parental concerns and misinformation about the efficacy and safety of HPV vaccine remain barriers to reaching public health vaccination goals. Physician and clinic-based interventions have shown some limited positive effect on vaccine uptake. However, parental barriers to HPV vaccination may ideally be addressed by digital interventions (in this case, smartphone applications) that are tailored to their concerns. Specifically, research indicates there is a great deal of: (1) confusion and uncertainty about HPV vaccine, and (2) concomitant misinformation about HPV vaccine, who it is meant for, and the conditions under which it is maximally effective.

With funding from the Patient Centered Outcomes Research Institute (PCORI) and the National Cancer Institute, Dr. Woodall’s team systematically developed a set of mobile web app tools to prompt the informed adoption of HPV vaccination. They used Diffusion of Innovations Theory and related research on Informed Decision Making to guide the iterative development of mobile apps for parents of young female and male adolescents.

Ms. Reither presented a poster that reported the results of developmental research and early trial findings from two smartphone web app projects — one focused on parents and adolescent girls (ages 11-14) and the other on parents and adolescent boys in the same age range. The objective of these investigations is to develop and evaluate a mobile web app to encourage HPV vaccination in New Mexico, an ethnically-diverse state. Current ongoing randomized controlled efficacy trials with parents and their adolescent children in New Mexico clinics provide data to determine the impact of these mobile web apps on informed decision making and uptake for the HPV vaccine.

Dr. Woodall participated in a panel session entitled “Uses of New Technologies in HPV Vaccine Behavioral Science Research.” He gave a presentation on the design, development, and testing of the innovative Vacteens web app. New technologies and social networking sites like this can be used to understand sources of information and misinformation about HPV vaccination, engage parents and youth, and encourage HPV vaccination.

The progress and initial results of these ongoing research efforts will have implications for reaching HPV vaccine uptake goals set by Healthy People 2020 in the United States. Mobile web-based interventions show promise for reaching HPV vaccine uptake goals. A mobile web app can make decision-making tools widely available on popular mobile platforms such as tablet computers and smartphones, as well as personal computers.

This research was funded by grants from PCORI and the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Collaborators included Dr. Alberta Kong, Dr. Randall Starling, Dr. Lance Chilton, and Dr. Tamar Ginossar from the University of New Mexico; Dr. Greg Zimet from Indiana University; and Dr. David Buller and Jeanny Reither from KB. 


Dr. W. Gill Woodall and Jeanny Reither from Klein Buendel
INSIGHTS ON HPV VACCINATION FROM MOTHERS’ COMMENTS ON FACEBOOK POSTS IN A RANDOMIZED TRIAL

INSIGHTS ON HPV VACCINATION FROM MOTHERS’ COMMENTS ON FACEBOOK POSTS IN A RANDOMIZED TRIAL

HPV vaccine uptake among adolescent girls in the United States remains below the national goal of 80%. Parent decisions to vaccinate daughters can be impeded by confusion, uncertainty, and misinformation about the Human Papilloma Virus (HPV) vaccine. Dr. David Buller from Klein Buendel (KB) presented an analysis of mothers’ beliefs about vaccinating their adolescent daughters for HPV at the Eurogin International Multidisciplinary HPV Congress in Lisbon, Portugal, December 2-5, 2018.

Mothers with adolescent daughters from 34 states (n=880) were recruited to participate in a randomized controlled trial evaluating a social media campaign on adolescent health. The mothers’ beliefs were expressed in comments to posts on HPV vaccination in a social media campaign on adolescent health. Participants were recruited through Qualtrics survey panels or local efforts at the Tennessee study site. Eligibility criteria were: having a daughter aged 14-17, living in one of 34 states without a complete ban on indoor tanning for minors, using a Facebook account 1+ times a week, being able to read English, consenting to participate, completing the baseline survey, and willing to join the Facebook group. The campaign, implemented through Facebook private groups, included posts on HPV vaccination, as one of seven general health topics. The experimental manipulation varied posts on indoor tanning versus prescription drug abuse prevention. Posts on HPV vaccination and reactions and comments from mothers were extracted.

Mothers had a mean age of 43.1 years; 6.5% were Hispanic and 86.6% white; and 63.1% reported that their daughter had been vaccinated for HPV (17.8% receiving two shots and 31.5% three shots). HPV vaccination posts received on average 1.3 reactions and 3.3 comments from mothers. Comments often formed a dialogue among mothers. More than half of the comments (52.8%) were favorable, indicating that the daughter had been vaccinated and HPV vaccination reduced mothers’ anxiety, HPV infection rates, and related disease risk. However, 45.3% were unfavorable, citing safety concerns, lack of efficacy, unknown long-term consequences, inappropriate age for the vaccine, apprehension by other mothers, fears of vaccine tampering, lack of physician support, and sexual activity issues (for example, plans to wait until daughter becomes sexually active or using vaccine to guard against unprotected sex). Some commented, mostly favorably, on the need to vaccinate boys.

Facebook comments indicated both support for and resistance to HPV vaccination by mothers in the United States. Reasons for not vaccinating girls were similar to barriers expressed in other research and reflected negative media coverage of HPV vaccination. Effective strategies are needed in social media to counter misinformation on and resistance to HPV vaccines.

This research was funded by a grant from the National Cancer Institute (CA192652; Dr. David Buller, Principal Investigator). Collaborators include Dr.Barbara Walkosz and Julia Berteletti from KB; Dr. Sherry Pagoto and Jessica Oleski from the University of Connecticut, and Dr. Katie Baker from East Tennessee State University.

Eurogin is one of the most important conferences in the world on HPV infection and related cancers. The international gathering examines public health, health services, screening, and prevention of HPV-induced cancers.

Developing and Testing E-Training to Enhance Care of Aged and Dying Prisoners

Developing and Testing E-Training to Enhance Care of Aged and Dying Prisoners

Klein Buendel (KB) collaborator, Susan Loeb, PhD, RN, described the development and testing of computer-based training for corrections staff on caring for aged and dying prisoners in a poster she presented at the National Commission on Correctional Health Care (NCCHC). The conference was held in Las Vegas, NV from October 20-24, 2018.

The Enhancing Care of the Aged and Dying in Prisons (ECAD-P) training program is a collaboration between KB and Penn State University. The research team, which includes KB Senior Scientist, Dr. Valerie Myers and KB’s Creative Team, built upon electronic file training materials that had been developed at Penn State University, and transformed them into interactive computer-based training that is relevant to a broad spectrum of correctional staff.

Approaches employed in an earlier phase of this research included: (a) engagement with an Expert Advisory Board, including representatives from corrections, geriatrics, and hospice; (b) a Community Advisory Board constituted by corrections officials and returning citizens; (c) an environmental scan conducted with corrections training officers and information technology staff; (d) a modified Delphi survey with geriatric and corrections nurses; and (e) initial in-person usability testing of an early version of three training modules. In a second phase, usability testing of six modules was conducted in a large jail in the Northeast and a State Correctional Institution in the Midwest.

Analytic approaches employed throughout this research included content analysis, geriatric content identification, and acceptability, feasibility, and usability evaluation using qualitative observation approaches and the System Usability Scale. The Phase I study established proof of concept, produced three prototypical modules, a drafted a detailed specifications document for full program development in Phase II. Phase II included refinement of Phase I learning modules and development of three additional modules. Phase II assessments showed that the program is acceptable, feasible, and usable in corrections.

The NCCHC poster concluded that correctional settings across the United States face growing demands to better address the health care and management needs of aged, chronically ill, and dying inmates. The ECAD-P computer-based training holds promise to contribute to better preparation of correctional staff to effectively care for these populations.

This research was funded by a Small Business Technology Transfer (STTR) grant to KB from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators/coauthors in addition to Dr. Loeb and Dr. Myers include Dr. Erin Kitt-Lewis from the Penn State University College of Nursing.

Results of a Randomized Trial of the Way To Serve Responsible Alcohol Server Training

Results of a Randomized Trial of the Way To Serve Responsible Alcohol Server Training

Alcohol use and misuse is a leading cause of preventable death in the United States. Alcohol servers may help prevent alcohol-impaired car accidents and other harms by discouraging overconsumption by patrons. Responsible beverage service (RBS) training is designed to improve serving behavior, especially by avoiding selling too many drinks to a patron, refusing sales to intoxicated patrons, and properly checking identification to prevent sales to minors. Positive evaluations of RBS programs have been reported, yet online technologies hold promise for improving training quality, fidelity, cost, and uptake.

In a recent publication in the Journal of Studies on Alcohol and Drugs, researchers led by Klein Buendel (KB) Senior Scientist, Dr. W. Gill Woodall, reported the results of a randomized trial of the media-rich, interactive web-based WayToServe® (WTS) RBS training. The study hypothesized that servers who completed the WTS training would refuse alcohol service to apparently-intoxicated patrons at significantly higher rates compared with servers who completed the usual and customary (UC) live training.

In the study, alcohol-serving establishments (such as bars) in New Mexico were randomly assigned to receive WTS training (n=154) or the UC live training (n=155). Establishments were assessed before training, immediately after training, at six months after training, and at one year after training with a pseudo-intoxicated patron protocol (in which buyers were trained to enacting documented behavioral signs of intoxication) to assess premise alcohol service during early to mid-evening hours. The primary outcome variable for the assessment was the proportion of apparently-intoxicated buyers who were refused alcohol service.

Results indicated significantly higher refusal rates for WTS than for UC premises at the immediate (WTS=68% vs. UC=49%) and the one-year post-training assessment points (WTS=68% vs. UC=58%), but not at the six-month post-training assessment (WTS=69% vs. UC=64%). Results also indicated that younger pseudo-patrons were consistently refused more often than older pseudo-patrons. The study concluded that RBS training can be delivered online, broadening the scale of distribution and making it a potentially more cost-effective way to reach alcohol servers with effective and beneficial RBS training.

A full description of the methods, results, and limitations of this study, as well as commentaries by Buvik & Rossow (2018) and Miller (2018), and an author response, can be found in the Journal of Studies on Alcohol and Drugs.

The research was funded by the National Institute on Alcohol Abuse and Alcoholism (AA014982; W. Gill Woodall, Principal Investigator) at the National Institutes of Health. Collaborators/coauthors include Dr. Randall Starling from the University of New Mexico, Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in California, Dr. David Buller from KB, and Dr. Paula Stranghetta from Paula Stanghetta & Associates, Inc. in Ontario, Canada. KB’s Creative Team produced the WayToServe® web-based training. WayToServe® has been licensed to Wedge Communications LLC for commercial sale and distribution.

Results of Train To Tend Presented at APHA

Results of Train To Tend Presented at APHA

To date, ten U.S. states and the District of Columbia (DC) have legalized the use and/or sale of recreational marijuana. Training in responsible sales practices in the alcohol market has reduced sales to minors and, in some cases, intoxicated patrons. Responsible sales practices training could have similar benefits in the recreational marijuana market.

Dr. David Buller, Director of Research at Klein Buendel (KB) presented the results of the implementation and effectiveness trial of Train To Tend at the Annual Meeting and Expo of the American Public Health Association (APHA) in San Diego, California, November 10-14, 2018. APHA’s annual conference is the largest annual gathering of public health professionals with over 12,000 attendees.

Train To Tend is a unique responsible marijuana vending (RMV) training program developed by KB scientists and staff. The online RMV training was developed through input from state regulators, local law enforcement personnel, Colorado Marijuana Enforcement Division’s curriculum standards, interviews with recreational marijuana store personnel (n=15), and usability testing of a prototype training with store personnel (n=19). The RMV training contained five modules: State laws and regulations, ID checking, health effects of cannabis, customer service practices including recognizing intoxicated patrons, and rules of the trade including inventory tracking.

In a randomized controlled trial enrolling state-licensed retail recreational marijuana stores (n=225) in Colorado, Oregon, and Washington State, 125 stores were randomly assigned to receive the RMV training. Trainees completed pre- and post-training surveys evaluating usability and effects of the training. A total of 459 cannabis store employees completed the online training in 55 stores in the three states between June 2017 and February 2018. The training improved trainees’ ability to check IDs, their confidence to use the state’s inventory tracking system, and their ability to recognize intoxicated customers. Most trainees found the training to be user-friendly (78.4%), were satisfied with it (68.8%), and would recommend it to another employee (91.1%).

Overall, online RMV training was acceptable to retail recreational marijuana personnel and appeared to improve responsible sales practices. Training in responsible sales practices has been a successful policy intervention in the alcohol market that should be considered for the recreational marijuana market.

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). APHA presentation collaborators include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in Oakland, California; and Dr. Gill Woodall, Andrew Grayson, Mary Buller, and Sierra Svendsen from KB. Research details and more results of this study have been reported in an e-publication in the Journal of Public Health Management and Practice.

Technology, Social Media and Behavior Change

Technology, Social Media and Behavior Change

Klein Buendel (KB) Senior Scientist, Dr. Valerie Myers, was an invited presenter at The Colorado Cancer Coalition Annual Symposium held November 8-9, 2018 in Lakewood, Colorado. The mission of the Coalition is to eliminate the burden of cancer in Colorado. This year’s symposium, Elevating Personalized Cancer Care in Colorado, shared updates on innovative cancer care in Colorado and provided education and networking opportunities for professionals who work in cancer prevention, control, treatment, and survivorship.

Dr. Myers spoke about Technology, Social Media and Behavior Change in a session on Using Technology and Social Media to Advance Your Mission. She addressed multiple types of mHealth and eHealth technologies and the research behind their use in implementing health behavior change programs. Using her active research project Caminemos Juntas as an example, she was able to showcase how a smartphone app like Caminemos Juntas can be used to help Latina women overcome barriers to physical activity.

Dr. Myers said, “The benefit of technologies and digital health tools is that they have the capacity to be used in the real world with real people. That is their appeal.” She also stressed the importance of the use of digital technologies saying, “People who normally wouldn’t have access to empirically based and theory driven interventions now have access to them, so it really promotes the ability for scale up. I think this is where individual clinical trial-based health and public health come together really well, because you can translate what’s been done in rigorous trials and get it to the people to see if you can move the needle on these health behaviors.”

In addition to its importance, Dr. Myers said that digital health technologies such as mHealth and eHealth are “the way to get interventions in the hands of people that may never have been exposed to this messaging. If it can reach those individuals who have been neglected traditionally by health intervention and also meet people in a place where they feel comfortable and safe and are ready for change, then that excites me.”

KB scientists and staff have been active members of the Colorado Cancer Coalition and its Skin Cancer Task Force for over a decade.

Nightlife Safety Research

Nightlife Safety Research

Dr. Brenda Miller from the Pacific Institute for Research and Evaluation (PIRE) gave a presentation at the 9th Conference and Members’ Meeting of the European Society for Prevention Research (EUSPR) in Lisbon, Portugal, October 24-26, 2018. EUSPR “promotes the development of prevention science, and its application to practice so as to promote human health and well-being through high quality research, evidence based interventions, policies, and practices.” The research presented by Dr. Miller was designed and conducted in collaboration with scientists and staff from Klein Buendel (KB).

The study of nightclub patrons and their social drinking groups, tests an intervention called Nightlife Safety Plans (NSP). NSP is designed to reduce escalation of overuse of alcohol and drugs, physical aggression, and sexual aggression during an evening at the club. NSP relies on social groups that arrive at the club together to identify early signs of problems and to take actions to intercede. The actions are: Outreach, Options, and Out.

Data analyzed in this presentation consisted of 352 groups (961 participants) gathered over 41 Friday and Saturday nights at seven different clubs in the Bay Area of California. Data from online surveys, alcohol breath tests, and biological drug tests (post-test only) were gathered at entrance and exit for pre- and post-test assessments of the intervention effects. Biological measures reveal at least one club patron per group was legally intoxicated (Breath Alcohol Concentration—BAC, >.08%) in 60% of groups and at least one patron was positive for drugs in 50% of the groups. Further, at least one club patron per group experienced physical and/or sexual aggression within 40% of the groups.

Results indicated that experimental groups were significantly more likely to intervene with group members, using a significantly higher number of intervention strategies (Outreach, Options, and Out), to assess situations for physical aggression and sexual harassment, and to respond to friends experiencing sexual harassment. Further, experimental groups used significantly more protective strategies to keep group members safe. Reduced levels of alcohol use and intoxication or impairment (BAC > .05), as assessed by breath tests, were found among the groups in the experimental as compared to the control condition.

In summary, groups provide an opportunity to deliver and implement peer-focused safety strategies to enhance safety during the time spent in the club. The research’s focus on clubs also reaches young adults who are working (two-thirds were not in college), whereas many of these types of interventions are targeted toward college students.

This research was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA022331; Dr. Brenda Miller, Principal Investigator). Collaborators included Veronica Rogers, Dr. Hilary Byrnes, Dr. Mark Johnson, and Dr. Joel Grube from PIRE; and Dr. David Buller and Julia Berteletti from KB.

 

Using Targeted Photographs to Improve Health Messages for Stigmatized Populations

Using Targeted Photographs to Improve Health Messages for Stigmatized Populations

In a recent e-publication in the Journal of Health Communication, Mary Buller, President of Klein Buendel, and her coauthors report results of an evaluation of using Real Health Photos in health communication messaging. Real Health Photos is a unique collection of images of people with diversity of age, gender, race, ethnicity, income level, and health condition. The collection was produced by Klein Buendel to portray the diversity of health through photography and promote the inclusion of all populations in health promotion materials and media.

Of particular concern is how to reach underserved populations with effective health messages. Underserved groups with particular health needs — including people with disabilities, the elderly, and the overweight or obese — are underrepresented in popular media images and are often stigmatized so that they have to deal with prejudice and ostracization.

This research project tested the prediction that photographs depicting people very similar to the target population of a health message would improve the health communication and increase the  target populations’ intentions to change behavior in a favorable, more healthful direction. The evaluation of using Real Health Photos in health communication messaging was guided by the homophily principle. The homophily principle — that perceived similarities among people produce positive reactions — is a cross-cultural, global phenomenon and is grounded in the power of identification. Specifically, the study tested two hypotheses: (1) whether a health communication message will be more effective (that is, create stronger behavioral intentions to increase physical activity and eat a healthy diet) when incorporating photographs that match the target population than photographs that do not match the population in disability, age, or weight; and (2) whether the effectiveness of photographs that match the population on disability, age, or weight will be mediated by identification with persons in the photographs (that is, matched photographs will increase identification relative to unmatched photographs and increased identification will be associated with greater behavioral intentions).

To test the hypotheses, three nationally-representative samples of adults (n=1,796) who were physically-disabled, elderly, or overweight/obese were selected from a large national survey panel. Participants read an identical message promoting increased moderate to vigorous physical activity and decreased intake of high fat, high sugar, and high carbohydrate foods. Photographs from a commercial stock photograph service versus photographs created for the research project to match the three populations — from Real Health Photos — were included in the messages. Participants responded to assessments of behavioral intentions, outcome and self-efficacy expectations, and identification. Statistical analysis confirmed that Real Health Photos that matched the specific target population increased behavioral intentions mediated by identification in the physically-disabled and overweight/obese samples. Matched visual images improved health message effectiveness by capitalizing on the homophily and identification processes.

The development of Real Health Photos and this research were funded by a Small Business Innovation Research grant from the National Institute of Minority Health and Health Disparities (MD003338; Mary Buller, Principal Investigator). Coauthors include Dr. Peter Andersen from San Diego State University, Dr. Michael Slater from The Ohio State University, Dr. Kim Henry from Colorado State University, Lyndsay Fluharty from Telligen, Inc., and Dr. Erwin Bettinghaus, Xia (Lucia) Liu, Steven Fullmer, and Dr. David Buller from Klein Buendel. Many of the Real Health Photos used in this study were taken by Delia Palmisano from Blue House Photography in Denver, Colorado.