KB Collaboratory

Klein Buendel (KB) Senior Scientist, Dr. Gill Woodall, is the Principal Investigator leading a new research project aimed at reducing intoxicated driving by people with court-ordered ignition interlock devices (IIDs) through improved communication and support from family members.

Driving while intoxicated (DWI) remains a substantial and preventable source of morbidity and mortality in the U.S. The IID, which requires a driver to blow into a breathalyzer unit installed in an automobile to establish sobriety, reduces drunk driving while installed. However, research has shown that once IIDs are removed from DWI offenders’ cars, DWI recidivism levels return to those comparable to offenders who did not have an IID installed.

This new project will fully develop and evaluate B-SMART — smartphone technology to teach coping skills, communication skills, and strategies to help deter DWI. Unique to this intervention are the involvement of family members in supporting the DWI offender to not drink and drive, English and Spanish language options, and the use of smartphone technology to make that support immediate, accessible, and diffusible. The core content of the intervention is based on empirically-validated couples therapy curriculum developed by Dr. Barbara McCrady from the University of New Mexico. It will be adapted for concerned DWI offender family members and delivered through a convenient smartphone web app platform. Programming and usability testing will be done by KB designers and developers.

Results of a Phase I feasibility study of an initial module of B-SMART presented at the Research Society on Alcoholism by Dr. Woodall in 2016, showed very positive reactions by users. Thirty-two concerned family members of DWI offenders browsed the communication skills module of B-SMART and then rated the module on the System Usability Scale (SUS – Bangor, et al., 2011). Results indicated an average SUS rating of 44.2 (sd=4.78, scale range: 10-50), with 87% of participants rating the B-SMART module 40 or above. These results indicate that users found the prototype B-SMART module easy to use, informative, and very positive.

For the new Phase II evaluation, a randomized efficacy trial will be conducted with DWI offenders and their concerned family members recruited through the New Mexico court system. The research is funded by the National Institute on Alcohol Abuse and Alcoholism (R44AA022850) through the Small Business Innovation Research Program. Dr. Woodall’s scientific collaborators include Ms. Julia Berteletti from KB, Dr. Barbara McCrady and Dr. Vern Westerberg from the University of New Mexico, and Dr. Gary Cutter from Pythagorus, Inc. in Alabama.

Pinpoint: A Pain Management Tool for Teens with Sickle Cell Disease

September 24, 2018 Klein Buendel

Klein Buendel (KB) Senior Scientist, Dr. Valerie Myers, is the Principal Investigator leading a new research project to improve a self-care and pain management tool for teens with Sickle Cell Disease (SCD). SCD is the most common inherited blood disorder in the U.S. It affects primarily African Americans and Hispanics. Approximately, 100,000 people in the U.S. suffer from SCD and serious, painful complications can have a significant impact on well-being and quality of life.

Using interactive technology accessible on computers, tablets, and smartphones, the Pinpoint app will combine education, healthy living tips, and tools for managing pain through at-home techniques like relaxation, self-reflection, and a better understanding of the different types of pain teens might experience (acute versus chronic pain).

In a Phase I project, an initial prototype of Pinpoint was developed and reviewed. It included a Pain Assessment Tool, vocabulary game, body scanner reflection, educational self-disclosure activity, and excerpts from the Hope and Destiny Jr. book authored by Hsu, Rodrigues, and Brandalise. Four healthcare providers were interviewed on the app’s acceptability and potential function within the clinical practice. Sixteen teens participated in cognitive interviews, focus groups, and usability testing. The System Usability Scale (SUS; Bangor et al., 2011), a validated tool for assessing the usability and acceptability of technological products, served as the primary outcome. The preliminary SUS score well above average, suggesting a high level of acceptability and usability among users.

The full Pinpoint app being developed in the new Phase II study can be used in healthcare settings to reduce barriers in obtaining information from adolescents by using technology they are comfortable with and enjoy using, while also providing important pain data to healthcare teams and family that affect treatment options. By empowering teens with knowledge and enhanced communication skills, Pinpoint can help reduce emergency room visits and assist SCD teens to transition more successfully to adulthood with independence.

The Pinpoint project is being funded by the National Institute on Minority Health and Health Disparities at the National Institutes of Health (MD010746). It is being conducted in close partnership with the Hilton Publishing Company (HPC), the publisher of Hope & Destiny Jr., a leading book for teens on SCD management. Dr. Myers’ research collaborators include Ms. Mary Buller from KB, Dr. Lewis Hsu from the University of Illinois, Mr. Allan Platt from Emory University in Georgia, Dr. Gary Cutter from Pythagorus, Inc. and the University of Alabama at Birmingham, and Dr. Hilton Hudson from HPC. KB’s developers will design and program the Pinpoint app.

Implementation and Effectiveness of an Online Responsible Vendor Training Program for Recreational Marijuana Stores

September 17, 2018 Klein Buendel

Since 2012, nine U.S. States and the District of Columbia (DC) have legalized recreational marijuana, and several other states are looking to follow suit in coming years. At the outset of the legalization of recreational marijuana, the U.S. Department of Justice (DOJ) informed these states that they must put robust constraints into place that prevent youth access to marijuana. To accomplish this DOJ objective, Dr. David Buller and Dr. Gill Woodall from Klein Buendel (KB), and their co-authors created Train To Tend, an online responsible marijuana vendor (RMV) training program that aims to provide retail marijuana staff with the knowledge and skills they need in order to sell marijuana responsibly, and keep their communities safe. In a recent e-publication in the Journal of Public Health Management and Practice, the authors report the results of the implementation and evaluation of Train To Tend and what these results could mean for future research and policy.

Train To Tend was created with input from state regulators and local law enforcement personnel, curriculum standards published by the Colorado Marijuana Enforcement Division, interviews with recreational marijuana store personnel (n=15), and usability testing of a prototype training with store personnel (n=19) in Colorado and Washington State. Of all the input from these various stakeholders, retail marijuana store personnel reported that comprehensive training in responsible sales practices was uncommon in the industry. Coupled with the DOJ objective of preventing youth access to marijuana, this finding demonstrated a need for RMV.

Once all stakeholder input was reviewed, Train To Tend was created, and the training ultimately contained five modules: state laws and regulations, ID checking, health effects of marijuana, customer service practices including recognizing intoxicated patrons, and rules of the trade.

In a randomized controlled trial, the training was tested using a random sample of state-licensed recreational marijuana stores (n=225) in Colorado, Oregon, and Washington State. One hundred twenty-five stores were randomly selected to receive Train To Tend, while the remaining 100 stores received the usual and customary training in their state. In total, 420 store employees completed Train To Tend in 2017 and 2018. Pre- and post-training surveys were administered to Train To Tend trainees to gauge their perceptions of self-efficacy toward RMV practices, as well as their ratings of usability for Train To Tend.

Results revealed that the training improved trainees’ ability to check IDs, use their state’s inventory tracking system, and spot intoxicated customers. Also, most trainees felt very confident using the training, rated the training as user-friendly, and thought that the information and skills learned in the training would help keep their communities safe.

Overall, trainees’ improvement in confidence to engage in responsible sales practices, as well as the high levels of usability for Train To Tend they reported, suggests that programs like Train To Tend are feasible and potentially effective at training staff in recreational marijuana markets. In addition, this randomized-controlled trial provides a solid foundation upon which future research into RMV trainings can be built. This type of research is imperative to ensure the safety of customers that live in early-adopting recreational marijuana markets like Colorado, Oregon, and Washington State. By conducting research like this when recreational marijuana legalization is in its early stages, many unforeseen problems can be mitigated before they grow too large, and ultimately the public can be kept safer.

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

Way to Serve Tops 75,000 Trainings

September 12, 2018 Klein Buendel

WayToServe®, an evidence-based online responsible alcohol server training program, has achieved a significant milestone by surpassing 75,000 completed trainings. The program, developed by scientists at Klein Buendel, Inc. (KB), the University of New Mexico (UNM), and the Pacific Institute for Research and Evaluation, was initially evaluated in a controlled randomized trial that resulted in increased refusal of sales to intoxicated patrons. WayToServe® was then transferred from its research phase to commercialization in 2012. It was licensed to Wedge Communications LLC for marketing and distribution initially in New Mexico for training of on- and off-site alcohol servers.

Additional state-specific versions of WayToServe® have been created that conform to the Responsible Beverage Service curriculum requirements of the State of California, the Texas Alcoholic Beverage Commission, Washington State Liquor Control Board, and Oregon Liquor Control Commission. WayToServe® is now sold in California, New Mexico, Texas, and Washington. The Spanish version, WayToServe Español, is scheduled to be tested in New Mexico and Texas later this year.

Commenting on the milestone achievement, Dr. David Buller, KB Director of Research and WayToServe® Co-Investigator, said “Plans are underway to refresh the entire online training for the next 75,000 servers to learn to sell alcohol responsibly and keep their customers and communities safe.”

The creation and evaluation of the original WayToServe® program was sponsored by two grants from National Institutes of Health to UNM (Dr. W. Gill Woodall, Principal Investigator). The WayToServe Español research project is being funded by a Small Business Innovative Research (SBIR) grant to KB from the National Institute of Minority Health and Health Disparities (R44MD010405; Dr. W. Gill Woodall, KB Senior Scientist, Principal Investigator).

Sun Safety Curriculum for Grades K-5 is Now Free for Schools

September 5, 2018 Klein Buendel

Sunny Days Healthy Ways, an evidence-based sun safety curriculum that provides sun protection education for grades K-5, is now available free online by its authors at Klein Buendel, Inc. Schools can use the curriculum to fulfill the school-based goals of the Surgeon General’s Call to Action to Prevent Skin Cancer.

“I was inspired to remove any barriers to schools having access to the curriculum by previous Surgeon General Dr. Boris Lushniak’s impassioned presentation at the 4th Annual Conference on UV and Skin Cancer Prevention,” explained Mary Buller, President of Klein Buendel.

Sunny Days Healthy Ways provides an average of 15 lessons per grade, that teachers can tailor to their timeframe and needs. Prepared lesson plans, student activity sheets, storybooks, learning objectives, and common core standards minimize prep time and make teaching students about sun safety easy. Project-based learning and technology connections make it fun.

Skin cancer is the most common cancer in the U.S. and is increasing at an alarming rate. Even though skin cancer occurs mainly in adults, much of the damage was likely done during childhood. Long periods of unprotected sun exposure and severe sunburning as a child can lead to skin cancer and eye damage later in life. Good health habits started in childhood are more likely to last a lifetime.

Sunny Days Healthy Ways was first created and evaluated with research grants from the National Cancer Institute (CA62968 & CA23074) and the Arizona Disease Control Research Commission (9403). To access the free curriculum, visit the Sunny Days Healthy Ways website at https://www.sdhw.info/.

Real Health Photos – Yoga Awareness Month

August 28, 2018 Klein Buendel

September is National Yoga Awareness Month. Yoga is a mind and body practice with historical origins in ancient Indian philosophy. Like other meditative movement practices used for health purposes, various styles of yoga typically combine physical postures, breathing techniques, and meditation or relaxation.

According to the National Center for Complementary and Integrative Health at the National Institutes of Health, millions of Americans of all ages practice yoga each year. Many people who practice yoga do so to maintain their health and well-being, improve physical fitness, relieve stress, and enhance quality of life. They may also be addressing specific health conditions, such as back pain, neck pain, arthritis or anxiety.

KB’s Real Health Photos stock photography enterprise includes thousands of images to help organizations visually illustrate people being physically active for better health. Real Health Photos images show diversity of gender, race, ethnicity, age, income level, and health condition.

Use Real Health Photos for improving the impact of health campaigns for all kinds of people, including people practicing yoga.

For more images, visit Real Health Photos.

Real Health Photos is a stock photography service owned and operated by KB. It was created and evaluated with a research grant (R44MD003338, Mary Buller, Principal Investigator) from the National Institute of Minority Health and Health Disparities at the National Institutes of Health. Real Health Photos is designed to capture the diversity of health through photography and promote the inclusion of all populations in health promotion materials and media.

Effect of an Occupational Skin Cancer Prevention Program on Employee Sun Safety Practices

August 23, 2018 Klein Buendel

Exposure to the sun’s UV rays is the biggest risk factor for skin cancer. It is also the easiest risk factor to modify through practicing sun-safe behaviors. Outdoor workers are at an elevated risk for skin cancer, especially melanoma, due to the amount of UV exposure they endure over the years. In a recent ePub-ahead-of-print paper in the Journal of Occupational and Environmental Medicine, Klein Buendel’s Dr. Barbara Walkosz, Dr. David Buller, Ms. Mary Buller and their co-authors discuss the outcomes of the follow-up assessment to Sun Safe Workplaces, a workplace sun safety program that promoted sun safety policy adoption and education.

Two years after the Sun Safe Workplaces intervention, a follow-up assessment was conducted to determine the impact of the program on employee sun safety behavior. All participants of the original intervention (n=98) were invited to partake in the two-year assessment and 63 (n=33 for intervention, n=30 for control) participated. The sample included local government organizations throughout Colorado with outdoor workers in at least one of the following service areas: parks and recreation, public works, and public safety. Project staff visited each employer to evaluate the sun protection policies in place, sun protection messages, and personal sun protection equipment available at each organization. An assessment of the sun safety policies was conducted that included three domains (administrative procedures, environmental controls, and personal protection practices) with 15 content categories. Additionally, policy implementation was measured through senior manager and line supervisor reports on whether or not employers communicated or provided training about sun safety to employees and/or provided any of the types of the recommended personal sun protection equipment for employees (sunscreen, wide-brimmed hats, sunglasses, long-sleeved shirts, long pants, or outdoor shade). Lastly, key contact managers were asked to assist study staff with distributing self-administered surveys to front-line supervisors and employees who worked outdoors, which included time spent outdoors at work, frequency of sun protection at work, prevalence of sunburn in the past 12 months on the job, attitudes toward occupational sun safety and self-efficacy for sun safety on the job, attitudes toward workplace health and sun safety policy, and job and demographic information. A total of 1,784 (n=913 for intervention, n=871 for control) outdoor workers completed surveys.

Results showed that compared to control workplaces, employees in the intervention workplaces reported more sun protection practices overall as well as more frequent use of sunscreen on the body, wearing of wide-brimmed hats, and more often had sunscreen, sunglasses, and a hat with them when at work. Employees in the intervention workplaces also reported fewer sunburns than those in the control workplaces. Additionally, sun protection messages and equipment, as well as employee training in sun safety, were more likely to occur in intervention workplaces and such actions increased the frequency of employees having sunscreen, sunglasses, and a hat on the job. For employees at employers with a best-practice policy, the total composite sun safety score was significantly higher than in the no-policy group and employees also reported more frequent use of sunscreen on the face and other exposed body parts and having sunscreen, sunglasses, and a hat with them while at work compared to those at no-policy employers. However, unlike the intervention group, there was no effect of policy on the prevalence of sunburns among the employees.

The authors concluded that policy adoption is an important step towards improving sun protection and preventing sunburns on the job for outdoor workers but recommend that a robust approach that includes a policy, training for employees, and personal protection equipment that can support sun safety is needed to effectively change employees’ sun protection behaviors.

This research was funded by a grant from the National Cancer Institute at the National Institutes of Health (RO1CA134705; Dr. David Buller and Dr. Barbara Walkosz, Principal Investigators). Coauthors included Ms. Mary Buller, Dr. Alan Wallis from University of Colorado Denver, Dr. Richard Meenan from the Kaiser Permanente Center for Health Research, Dr. Gary Cutter from Pythagoras, Dr. Peter Andersen from San Diego State University, and Dr. Michael Scott from Mikonics.

Skin Cancer Awareness and the Great Outdoors

July 30, 2018 Klein Buendel

In July, Klein Buendel (KB) teamed up with the Colorado Skin Cancer Task Force (CSCTF) and Rocky Mountain Sunscreen (RMS) for the first time in the summer to raise awareness about UV radiation and skin cancer prevention at the new-to-Denver Outdoor Retailer Summer Market at the Colorado Convention Center.

For nearly a decade, KB and the CSCTF partnered with RMS at the winter SnowSports Industries America Snow Show every January to show outdoor retailers that practicing sun safety is just as important in the winter months as in the summer months. Now we can access hundreds of outdoor retailers in the summer months in Denver, too, with the arrival of the Outdoor Retailer Summer Market.

Skin cancer prevention is particularly relevant for members of the outdoor retailer industry because they work and promote recreation in high UV environments, like mountains, deserts, lakes, and oceans. In addition to providing sun safety and skin cancer awareness information, the booth offered a unique opportunity for attendees to have a UV-damage photograph taken of their face with the Reveal Imager. The Reveal Imager by Canfield has the ability to capture damage caused by the sun’s UV rays that are invisible to the naked eye. Participants reported that seeing this type of photograph of themselves is a helpful visual reminder to practice sun safety all year long to reduce their risk of additional sun damage.

Per their website, “the Outdoor Retailer Summer Market is North America’s largest tradeshow in the outdoor industry drawing attendees from around the world. Summer Market is all about face-to-face—it’s where products are shown, orders are written, new accounts are found, connections are made and brands are launched. This show is about buying, sourcing, strategic meetings, trend, education and networking with decision makers, influencers, stakeholders, key buyers and athletes that influence the outdoor market.”

Over the course of the multi-day event, KB staff took dozens of photographs with the UV camera. Other members of the CSCTF (including Colorado dermatologists and dermatology interns) answered questions, distributed sun safety materials, and performed skin examinations. This event is part of the annual outreach and education efforts of the CSCTF. KB has been an active member of the CSCTF for over 10 years.

Collaborator Spotlight:
Dr. Robert Saltz

July 23, 2018 Klein Buendel

Robert Saltz, Ph.D. is a Senior Research Scientist at the Pacific Institute for Research and Evaluation (PIRE) in Berkeley, California.

He received his Ph.D. in Sociology from the University of Massachusetts. His research explores ways in which drinking context may influence the risk of subsequent injury or death. He has extensive experience researching “responsible beverage service” programs aimed at having bar and restaurant personnel intervene with patrons to reduce the risk of intoxication or driving while impaired.

Dr. Saltz collaborated with Dr. David Buller and Dr. Gill Woodall at Klein Buendel (KB) on the development, trial, and commercialization of the WayToServe^® responsible beverage service training program funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA; W. Gill Woodall, Principal Investigator).

Currently, Dr. Saltz is working with KB on two projects. He serves as a collaborating scientist with Dr. Woodall on WayToServe Español: A Culturally-Appropriate Online Responsible Beverage Service Training for Spanish-Speaking Servers (MD010405; W. Gill Woodall, Principal Investigator). For this project, he will assist with the creation of culturally-appropriate content and advise on the recruitment of alcohol sales premises. This study will systematically translate and test an alcohol server training intervention (WayToServe Español). The research will explore overcoming dissemination barriers with ethnically diverse and Spanish speaking restaurant and bar workers. The team will tailor it to be culturally specific and compatible with the values and needs of the employees, simple to adopt, accessible for trial, and observable in direct benefits and effects on responsible alcohol services. The randomized control trial will take place at Spanish-dominant businesses in the Southwestern region of the United States. …

Uptake of MC1R Testing for Melanoma Risk

July 10, 2018 Klein Buendel

The use of personalized medicine or tailoring medicine based on sequencing and analyzing an individual’s DNA, is drastically changing cancer research and treatment, risk assessment and clinical practices¹, and skin cancer is one area being affected by this research.² Currently, melanoma in U.S. Hispanic populations is on the rise and despite melanoma being more common in Caucasians than Hispanics, a melanoma diagnosis is more likely to be fatal for Hispanics.³

In a study recently published in JAMA Dermatology, several researchers (lead author Dr. Jennifer Hay) including Dr. David Buller from Klein Buendel, examined interest and uptake, as well as demographic and skin cancer risk factor covariates of interest and uptake, of the melanocortin-1 receptor gene (MC1R) saliva test among 499 adult participants recruited from diverse clinics in Albuquerque, New Mexico. Forty-four percent (44%) of participants were non-Hispanic white, 48% were Hispanic, and all were registered clinic patients for longer than six months, were 18-years of age or older, and spoke English or Spanish fluently. A study website log-in was given to participants to give them the option to log on and read three educational modules presenting the rationale and pros and cons of MC1R testing.

Results showed that almost 50% (n=232) of participants logged on to the website and that non-Hispanic whites and those with higher education were more likely to do so. Furthermore, participants with a history of sunburn and with at least one first-degree relative were also more likely to log on to the website. Of those who logged on, almost 90% (n=204) decided to request testing and a little over 80% (n=167) of those who requested testing returned the kit. Non-Hispanic whites and older participants had a higher rate of returning the kit.

Authors cite the large, diverse sample and the behavioral outcomes versus self-reported outcomes as strengths of the study while citing the single location and use of one primary care health system for recruitment as a limitation on generalizability. Lastly, authors conclude by calling for future research in socioeconomic and demographic discrepancies in interest and uptake of genetic testing in order to ensure ease of availability of genetic information seeking in the general population.

References

Orchard C. Genomic medicine in the real world: “hope” and “hype”. Harvard T.H. Chan School of Public Health Web site. Available at: https://www.hsph.harvard.edu/ecpe/genomic-medicine-in-the-real-world-hope-and-hype/. Published June 1, 2015. Accessed June 20, 2018.
Genetics of skin cancer (PDQ) – health professional version: genetic testing. National Cancer Institute Web site. Available at: https://www.cancer.gov/types/skin/hp/skin-genetics-pdq#link/_393_toc. Updated June 14, 2018. Accessed June 20, 2018.
Perez MI. Hispanics get skin cancer, too. Skin Cancer Foundation Web site. Available at: https://www.skincancer.org/prevention/are-you-at-risk/hispanic. Published May 25, 2016. Accessed June 20, 2018.