KB Collaboratory

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

October 23, 2018 Klein Buendel

Dr. Gregory Zimet is a Clinical Psychologist and Professor in the Department of Pediatrics at the Indiana University School of Medicine. Since he arrived there in 1993, he has guided an extensive, multi-faceted research program focused on attitudes about, and acceptance of, vaccines for the prevention of sexually-transmitted infections, including the human papillomavirus (HPV) vaccine.

Currently, Dr. Zimet serves as a KB collaborating scientist with Dr. Gill Woodall and Dr. David Buller on a research project entitled “Web App Technology for Boys and Parents: Improving HPV Vaccine Uptake.” Other collaborating investigators include Dr. Alberta Kong and Dr. Randall Starling from the University of New Mexico. The four-year HPV project, funded by a grant from the National Cancer Institute (CA210125; G. Woodall, PI), is designed to produce a mobile web app to accurately inform parents and adolescent boys about the HPV vaccination and address unique concerns about its safety and effectiveness for boys. The mobile web app is being developed for personal computers, smartphones, and tablet computers.

Dr. Zimet’s research also has involved randomized clinical trials designed to evaluate the effects of brief health communication messages on hepatitis B virus and HPV vaccine uptake, and on acceptance of HIV testing. Through his involvement over the past five years in the Adolescent Medicine Trials Network for HIV/AIDS Interventions, Dr. Zimet has expanded his research focus to examine factors related to recruitment of adolescents into biomedical HIV prevention clinical trials. Biomedical trials that may involve the recruitment of adolescents are related to pre-exposure prophylaxis, HIV vaccine, and microbicides. Some of his recent publications address HPV vaccination, microbicide acceptability among adolescents, and attitudes about HIV and herpes simplex virus type 2 testing.

Dr. Zimet has served as a research mentor to five physician fellows, over 20 pre- and post-doctoral fellows in psychology, social work, health behavior, and nursing, and several junior faculty in the Department of Pediatrics and the School of Nursing at Indiana University.

¡Caminemos Juntas!: A Smartphone App for Latinas to Connect with Walking Partners

October 15, 2018 Klein Buendel

Dr. Valerie Myers, Klein Buendel (KB) Senior Scientist, is the Principal Investigator leading a new research project aimed at helping Latinas combat barriers to physical activity using smartphone technology and social networks.

Hispanic women are a growing and influential segment of the population, yet health disparities for Latinas remain high. Latinas are more likely than their non-Hispanic White counterparts to be overweight, diagnosed with diabetes, and physically inactive. Regular physical activity promotes physical and emotional well-being, such as lower risk of heart disease and diabetes, weight management, and improved quality of life, yet physical activity interventions for Latinas remain limited.

Community-focused walking interventions produce improvements in physical activity and are well-received by Latinas when they are socioculturally sensitive. New technology has the ability to provide Latinas with innovative ways to connect socially and increase PA. Location-based services (LBS) are a popular technology that uses geographical positioning to allow individuals to use their smartphones to connect to their surrounding environment.

¡Caminemos Juntas! is a physical activity walking app that uses location-based services to connect Latinas within nearby neighborhoods as a way to provide social support for increased walking behavior. A prototype of the ¡Caminemos Juntas! app was programmed for both iOS and Android smartphones in a previous Phase I project. Multi-method formative research was conducted to guide app design and content prior to conducting field usability testing. To guide prototype development, a national sample of Latinas (n=98; mean age 32.7 +/- 7.8 years; 45% primary Spanish speaking; 28.6% with annual income < $15,000) were surveyed to better understand their preferences, usage, needs, and obstacles of current apps in relation to health and physical activity. Latinas’ current physical activity behaviors and smartphone use, opinions on health-related apps using LBS, how often they access social networking sites on their mobile phone, and their likelihood of using a social networking app to connect to others with intentions to be physically active were also examined.

Phase I results revealed that 22.5% never or rarely exercised, 73.5% accessed social networking sites daily with an average of 8 times a day, and 43.9% used LBS every day. Ease of use (82%), informationally accurate (79.2%), and reliability (84.7%) were app features rated as highly important. Over 63% reported high likelihood of using a social networking app to connect to others with the intentions of being physically active, and 67.4% reported that this type of app would be very helpful. Focus groups showed that the app was appealing, also.

In the new Phase II project, the ¡Caminemos Juntas! app will be fully developed and evaluated in a randomized control trial with Latinas aged 18-45 in San Jose, CA and Denver, CO. Changes in physical activity, social support for exercise, and quality of life will be evaluated. New features to be explored include Fitbit® device integration, mapping of walks, and social media integration. The LBS features of the app will allow Latinas to determine a safe place to meet for a walk, connect with other users nearby, and be notified if there was an available walk in the user’s vicinity.

The research is funded by the National Institute on Minority Health and Health Disparities (MD009652) at the National Institutes of Health through the Small Business Innovation Research Program. Dr. Myers’ collaborators include Dr. Abby King from Stanford University, and Dr. Gary Cutter from Pythagorus, Inc. in Alabama.

Use of AFIX-based Strategies for HPV Vaccination in Florida

October 8, 2018 Klein Buendel

Dr. Barbara Walkosz, a Senior Scientist at Klein Buendel (KB), is one of several authors on a recent publication reporting on Florida pediatricians’ use of AFIX-based strategies for human papillomavirus (HPV) vaccination of adolescents and young adults. The report is published in the journal Preventive Medicine. Research collaborators (coauthors) are from the Moffitt Cancer Center and Research Institute, the University of South Florida College of Medicine, Pediatric Partners, the Indiana University School of Medicine, and the Johns Hopkins University School of Public Health.

HPV vaccination is recommended by the U.S. Centers for Disease Control and Prevention (CDC) to significantly reduce the incidence of cervical, vaginal, oral, and other cancers caused by the sexually transmitted virus. A series of vaccinations are recommended for adolescents and young adults, preferably before the onset of sexual activity (9-26 years of age).

However, rates of HPV vaccination in Florida and the U.S. are disappointingly low – less than 50% for girls and less than 40% for boys. In an effort to increase HPV vaccination of pediatric patients, the CDC created and implements the AFIX quality improvement program with healthcare providers. AFIX stands for Assessment, Feedback, Incentives, and the exchange of information – the four key strategies of the program which is delivered to clinics by local health departments.

The Preventive Medicine paper reports on the results of a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida to assess the use of the AFIX strategies. Less than half of the physicians surveyed reported implementing any AFIX strategies, leaving room for program engagement, uptake, and improvement.

B-SMART Study Launches at KB

October 1, 2018 Klein Buendel

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.