#4Corners4Health

#4Corners4Health

A collaborative team of highly-experienced cancer prevention and control investigators from the Four Corners Cancer Centers Collaborative (University of Arizona, University of Colorado, University of New Mexico, and University of Utah), Colorado State University, and Klein Buendel is launching a research study that focuses on decreasing cancer risk factors among emerging adults (ages 18-26) living in rural counties in the “Four Corners” states (Arizona, Colorado, New Mexico, and Utah) using a social media campaign. Cancer risks related to infrequent physical activity, unhealthy diet, nicotine product use, alcohol intake, ultraviolet radiation exposure and lack of HPV vaccination are prevalent among emerging adults and contribute to cancer later in life.

The project will test a theory-based, multi-risk factor social media approach to cancer prevention through the use of Facebook and its private group function. Social media can improve information dissemination, credibility, and relevance, be used to detect and respond to emerging trends, and engage users with user-generated content that personalizes information. It offers a superior intervention for emerging adults compared to health care, schools, and workplaces which can be challenging to implement in low-resourced rural communities and will not reach many emerging adults who have low preventive health care utilization, school enrollment, and/or employment.

#4Corners4Health Specific Aims

  • Develop a social media intervention for diverse emerging adults in rural communities via a community-engaged process that combines expert advice, user-generated content, and online instruction about behavioral cancer risks, cancer misinformation, counter marketing, digital and media literacy, and family communication.
  • Evaluate the effect of a theory-based social media intervention on moderate to vigorous physical activity (MVPA), health eating patterns, nicotine product use, alcohol intake, sunburn prevalence, and HPV vaccination with the diverse (ethnically/ socioeconomically) population of emerging adults aged 18-26 in rural counties in the Four Corner states recruited from Qualtrics’ survey panel and enrolled in a pragmatic randomized trial using a stepped-wedge design in which individual emerging adults will be randomized to one of four cohorts and receive social media feed for varying durations in separate Facebook private groups.
  • Test if improvements in merging adults cancer risk knowledge and beliefs, digital and media literacy skills, accurate cancer prevention information, and family communication mediate impact of the social media campaign.
  • Explore whether the impact of the social media campaign differs according to a) level of emerging adults engagement with campaign, b) cancer risk factors, and c) biological sex of the participants.

The investigators hypothesize that (1) emerging adults will increase MVPA and healthy eating pattern, reduce nicotine product and alcohol use, and sunburns, and increase HPV vaccine uptake from pre to post when receiving social media campaign, and (2) positive impact of the social media campaign on cancer risk factors among emerging adults will be mediated by improved cancer risk knowledge and beliefs (self-response efficacy; norms; social support; vaccine antecedents), digital and media literacy skills, misinformation, and family communication.

This research will be led by Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico (Multiple Principal Investigators). It is being funded by a 5-year R01 grant from the National Cancer Institute (CA268037). Key collaborators include Dr. Kimberly Henry from Colorado State University; Dr. Cindy Blair from the University of New Mexico; Dr. Judith Gordon, Dr. Cynthia Thomson, and Dr. Jennifer Hatcher from the University of Arizona; Dr. Evelinn Borrayo and Dr. Douglas Taren from the University of Colorado; Dr. Deanna Kepka, Dr. Echo Warner, and Dr. David Wetter from the University of Utah; and Dr. Gill Woodall, Dr. Barbara Walkosz, Dr. Kayla Nuss, and Ms. Julia Berteletti from Klein Buendel.

Promoting Social Distancing and COVID-19 Vaccination in a Social Media Feed for Mothers

Promoting Social Distancing and COVID-19 Vaccination in a Social Media Feed for Mothers

The Health Chat team from Klein Buendel, the University of Connecticut, Colorado State University, and East Tennessee State University has published findings from a health communication study in the journal JMIR Infodemiology. The purpose of the study was to examine how the source of health information shared via a Facebook social media feed might impact behavioral intentions related to practicing social distancing or accepting COVID-19 vaccination. The Facebook group participants were mothers of adolescent daughters. The social media feed varied the source of information in posts on four topics: social distancing, COVID-19 vaccines, digital and media literacy, and family communication about COVID-19. The information sources were government agencies, near-peer parents, and news media.

In summary, 303 mothers with adolescent daughters from a previous study testing a social media campaign on indoor tanning were recruited in January 2021 and enrolled in a randomized single-factor design (government agencies vs. near-peer parents vs. news media) evaluating the 9-week Facebook feed with four assessments at baseline and 3-week, 6-week, and 9-week follow-ups. Mothers received one social media post each day (Monday-Friday) in three randomly assigned Facebook private groups, covering all four topics plus one additional post on a positive non-pandemic topic to promote engagement. Posts in the three groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Views, reactions, and comments related to each post were counted to measure engagement with the messages. Mothers reported on social distancing and vaccine intentions for themselves and their daughters at the four assessment points.

Research methods and analyses are detailed in the JMIR Infodemiology paper. Nearly all mothers (98%) remained in the Facebook private groups throughout the 9-week trial period, and assessment completion rates were high. Analysis showed that social distancing behavior by mothers and daughters decreased over time but vaccine intentions increased. Decrease in social distancing by daughters was greater in the near-peer source group and lesser in the government agency group. The higher perceived credibility of the assigned information source increased social distancing and vaccine intentions. Mothers’ intentions to vaccinate themselves may have increased when they considered the near-peer source to be not credible. According to the authors, decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652). Dr. David Buller from Klein Buendel and Dr. Sherry Pagoto from the University of Connecticut were the project’s Multiple Principal Investigators. Additional authors on this publication include Joseph Divito from the University of Connecticut; Dr. Kim Henry from Colorado State University; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; and Dr. Barbara Walkosz, Dr. Gill Woodall, Julia Berteletti, and Alishia Kinsey from Klein Buendel.

Effects of Engagement with a Social Media Campaign to Reduce Indoor Tanning

Effects of Engagement with a Social Media Campaign to Reduce Indoor Tanning

A paper by Klein Buendel scientists, staff, and collaborators published in the Journal of Health Communication reports on a secondary analysis of engagement effects from a social media campaign. The campaign, called Health Chat, was aimed at reducing mothers’ permissiveness for indoor tanning (IT) by their teenage daughters.

In the study, over 800 mothers with daughters aged 14-17 were recruited in 34 states that did not ban IT by minors under age 18 for a randomized trial. Follow-up assessments were completed at the end of the intervention (12 months) and six months after that (18 months). Daughters’ baseline and follow-up responses were analyzed also. Mothers received a Facebook feed on adolescent health topics that included posts about preventing IT (intervention) or prescription drug misuse (control).

Engagement was measured by extracting reactions (such as like or sad) and comments posted by mothers to the campaign posts. Overall, 76.4% of posts received a reaction and/or comment. Mothers who engaged with IT posts were less permissive of daughters’ IT immediately at the end of the campaign and six months after the intervention than mothers who did not engage with the posts.

Social media is a large part of the media diets of many parents and show some promise for health behavior change interventions. Social media posts need to both reach and engage parents, especially in social media like Facebook whose algorithm prioritizes posts from feeds that receive more views, reactions, and comments. This is to ensure that the posts appear in participants’ news feeds so well-crafted health communication can influence them. The authors conclude, however, that more work is needed on strategies to engage individuals with social media posts in the context of improving public policies that restrict minors’ access to IT facilities.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Kimberly Henry from Colorado State University; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Jessica Bibeau from the University of Connecticut; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.

Evaluation of the STAC
Teacher Module

Evaluation of the STAC
Teacher Module

Bullying is a significant problem for youth and is associated with a wide range of negative consequences. Educating teachers about bullying and training them to support students to intervene as “defenders” may increase the efficacy of bullying bystander programs. This is particularly important in middle school when bullying peaks and rates of reporting bullying to teachers begin to decline.

This study, published in JMIR Formative Research, used a mixed-methods design to inform the development of a Teacher Module as a companion training to a brief bullying prevention program for middle schools, called STAC. The STAC bystander intervention is a 75-minute training that includes didactic and experiential components. It teaches middle school students to act as “defenders” on behalf of targets of bullying through utilizing four intervention strategies:

STAC Bullying Bystander Strategies

(1) “Stealing the Show” – using humor or distraction to interrupt a bullying situation and remove the attention away from the target;

(2) “Turning it Over” – identifying a trusted adult at school, reporting, and asking for help during a bullying incident;

(3) “Accompanying Others” – befriending and/or providing support to a peer who was a target of bullying; and

(4) “Coaching Compassion” – gently confronting the perpetrator and increasing empathy for the target.

Providing students who witness bullying with intervention strategies to act as “defenders” can reduce both bullying and negative associated outcomes for both targets and bystanders.

For the development of the companion STAC Teacher Module, 18 teachers were recruited from one middle school in a rural, low-income community. Before and after the training, teachers completed surveys assessing immediate outcomes (such as knowledge, confidence, comfort, and self-efficacy), intention to use the program strategies, and program acceptability and relevance. After the final survey, a subset of six teachers participated in a qualitative focus group to obtain feedback regarding program appropriateness, feasibility, content, perception of need, and potential desire for an online version of the teacher training.

Study measures, procedures, analyses, and results are detailed in the JMIR Formative Research paper. Descriptive statistics, independent sample t-tests, and thematic analysis were used to analyze the data. In summary, the researchers found an increase in teacher knowledge and confidence to support “defenders,” confidence and comfort in managing bullying, and bullying self-efficacy. Most teachers reported they were likely or very likely to use the STAC strategies to support students who intervene in bullying in the future. Both quantitative and qualitative data showed the teacher training was easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on program improvement. Teachers shared positive feedback on program feasibility and implementation, and described strengths of an online version of the module. This study demonstrates the effectiveness of the STAC Teacher Module in increasing teacher knowledge and bullying self-efficacy and provides support for the development of an online version of the module for teachers.

This research was supported by a grant to Boise State University from the Mental Research Institute (Dr. Aida Midgett, Principal Investigator). Co-authors include Dr. Diana Doumas from Boise State University and Ms. Mary Buller from Klein Buendel.

Collaborator Spotlight:
Dr. Susan Breitenstein

Collaborator Spotlight:
Dr. Susan Breitenstein

Susan Breitenstein, PhD, RN, FNAP, FAAN, is an Associate Professor, Assistant Dean for Research and Innovation, and Senior Director of the Community Outreach and Engagement & CHW Training Program at The Ohio State University College of Nursing. She received her PhD from Rush University. Her clinical training is as a child and adolescent psychiatric nurse. Working clinically with children, adolescents, and families with mental health issues led Dr. Breitenstein to focus her research efforts on mental health promotion and prevention through implementation and dissemination of evidence-based parenting interventions. Her other research interests include fatherhood interventions and intervention fidelity. In addition to research, Dr. Breitenstein serves as Secretary of the Global Implementation Society.

Currently, Dr. Breitenstein is collaborating with Ms. Julia Berteletti from Klein Buendel on a research study entitled, “Parent Training for Parents of Toddlers Born Very Premature: A Factorial Design to Test Web Delivery and Telephone Coaching” (HD104072; Dr. Breitenstein, Principal Investigator). This study is an adaptation of the Chicago Parent Program and will focus on parenting children who were born very premature, or before 32 weeks gestational age. The Chicago Parent Program is a 12-session parenting program designed to reduce behavioral issues in young children, ages 2-5 years, through strengthening parenting skills. Children who are born very premature have higher risks and vulnerabilities for developing behavioral problems. This study aims to test digital delivery of parent training plus coaching calls for parents of toddlers who were born very premature.

Media Literacy Case Study

Media Literacy Case Study

Dr. Barbara Walkosz from Klein Buendel, Ms. Tessa Jolls from the Center for Media Literacy, Dr. Marilyn Cohen from the University of Washington, and Mr. Michael Danielson from Action 4 Media Literacy presented timely media literacy research at the National Association of Media Literacy Education Conference (July 15-17, 2022). Their virtual presentation was entitled, “Media Literacy Policy Enactment and Implementation: A Case Study of Washington State.”

As the need for media literacy across societal sectors is well established, citizens, educators, and policymakers increasingly recognize the necessity for a citizenry to have the skills to be able critically analyze and create media content. Primarily since the U.S. elections of 2016 and 2020 and the COVID-19 pandemic, media literacy is taking its place center-stage as an essential element for sustaining a democratic and a healthy society. Although efforts for media literacy education policy adoption are encouraging at the national and state levels, once adopted, policies and programs are sparsely funded and often not institutionally supported for a sustained period.

The case study of the adoption and implementation of media literacy in the state of Washington offers insights into successful strategies for long-term enactment of media literacy education. Diffusion of Innovations Theory provides a theoretical framework to explain and understand the adoption and implementation processes and offers a promising framework for media literacy policy implementation in other contexts.

EZPreemie Study Protocol

EZPreemie Study Protocol

A research team from The Ohio State University, Rush University, Nationwide Children’s Hospital, and Klein Buendel has published a paper describing a 5-year research project to develop and evaluate a technology-based, widely accessible, and effective form of behavioral parent training (BPT) delivery to address the unmet and unique needs of parents of very preterm children.

As presented in the paper published in BMJ Open, children born very preterm (gestational age <32 weeks) are twice as likely to demonstrate behavior problems such as aggression, non-compliance, temper tantrums and irritability compared with their term-born peers. While BPT is a gold standard for prevention and treatment of childhood problem behaviors, there are limited accessible and effective BPT interventions for families with children born very preterm. The paper describes a multi-center, randomized controlled protocol for a factorial design trial evaluating the independent and combined effects of the ezParent BPT intervention plus brief, weekly coaching calls on parent and child outcomes for families with toddlers born very preterm.

The BMJ Open paper details the study design, aims, intervention, measures, analysis plans, and procedures of the study which will employ a 2×2 factorial randomized design. Parents (n=220) of children aged 20–30 months corrected age who were born very preterm (<32 weeks) will be recruited from two large metropolitan Neonatal Intensive Care Unit follow-up clinics and randomized to one of four conditions: (1) ezParent (2) ezParent + coach, (3) active control or (4) active control + coach. A web-based app will provide behavioral training through brief videos, interactivity, reflection questions, and assessments. Data on parenting and child behavior outcomes will be obtained from all participants at baseline and 3, 6 and 12 months for program evaluation.

This research is being led by Dr. Susan Breitenstein from The Ohio State University (OSU) and Dr. Michelle Greene of Rush University (Multiple Principal Investigators). It is funded by a grant from The Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institute of Health (HD104072). Additional co-authors on this publication include Dr. Michael Schoeny and Dr. Kousiki Patra from Rush University; Dr. Sarah Keim from Nationwide Children’s Hospital and OSU; Dr. Mary Lauren Neel from Nationwide Children’s Hospital; Ms. Shea Smoske from OSU; and Ms. Julia Berteletti from Klein Buendel.

Training Cannabis Store Personnel in Responsible Vendor Practices

Training Cannabis Store Personnel in Responsible Vendor Practices

Dr. W. Gill Woodall, Klein Buendel Senior Scientist, participated in a panel discussion at the 45th Annual Scientific Meeting of the Research Society on Alcoholism, June 25-29, in Orlando, Florida. He presented data and results from a recent study assessing and training cannabis store personnel in responsible vendor practices. In the wake of a great expansion of recreational cannabis, the prevention of harms related to polysubstance use has gathered attention as well. Specific and effective prevention strategies are needed. One potential approach borrows from alcohol prevention – responsible sales and service.

Regulations in all state recreational cannabis markets prohibit sales of marijuana products to customers under age 21 and in a few markets, sales to intoxicated customers. Using pseudo-patron methods, our team assessed sales to underage-appearing customers in recreational cannabis stores in Colorado and Washington State (175 stores) in 2016-17 and sales to apparently alcohol-intoxicated customers in stores in Colorado, Oregon, and Washington State (150 stores) in 2018.

Refusal of underage-appearing pseudo-patrons were very frequent (92.6%). By comparison, refusal of apparently alcohol-intoxicated pseudo-patrons was infrequent in all three states (11.0%), even though Oregon state law explicitly prohibited it. An online survey of personnel from 59 stores in 2020 explored frequency of sales to these customers. Respondents indicated that underage customers attempted to enter stores frequently (66.1% several/many times) and customers entered stores who were intoxicated by alcohol (40.7%) or marijuana (44.1%). They often refused sales to customers (57.6% several/many times for any reason; 42.4% for being intoxicated). Management support was high for checking IDs (91.5% supported it a lot) but moderate for refusing to sell to customers appearing intoxicated (74.6%).

An online responsible marijuana vendor training created by Dr. Woodall and his collaborators from Klein Buendel and the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE) called “Train To Tend,” may have improved refusal to under-age customers at the entrances in stores that used it (trained stores: 65.9%, baseline, 82.5%, 3-month posttest, and 79.9%, 9-month posttest; untrained stores: 82.6%, 83.1%, 84.5% respectively), but did not seem to impact sales to intoxicated customers (intervention: 11.6%, control: 7.6%).

Deterrence due to state regulations or store policy for sales of cannabis products appears to be lower for sales to customers who appear intoxicated than underage customers in these cannabis markets. Training in responsible sales practices alone may not be successful when deterrence is low. Increasing deterrence may depend on regulators actively prioritizing the law to store licensees and monitoring compliance. Improve understanding of how regulatory policy and retail availability affect potential co-use of alcohol and cannabis in the legalized adult-use markets.

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). Dr. Woodall’s Co-Investigators include Dr. Robert Saltz from the Prevention Research Center at PIRE and Dr. David Buller from Klein Buendel.

STAC-T Phase II Project

STAC-T Phase II Project

A collaborative research team from Boise State University, Plymouth State University, the University of Mississippi, and Klein Buendel is launching a Phase II STTR research project to develop and evaluate the impact of a middle school intervention to reduce bullying and its negative consequences. The project is entitled “Translation of an In-Person Brief, Bystander Bullying Intervention (STAC) into a Technology-Based Program.” STAC uses four strategies in its bullying bystander intervention: “Stealing the show,” “Turning it over,” “Accompanying others,” and “Coaching compassion.”  

The project will use state-of-the-art technology to adapt a novel, evidence-based bullying bystander intervention to a user-centered, technology-based format for an underserved population with significant mental health disparities. STAC-T will extend the scope of the original STAC intervention by providing a delivery mechanism that increases access and reduces implementation barriers for schools in rural, low-income communities, as well as providing interactive, user-centered content. STAC-T will address both bullying and negative mental health outcomes for targets and bystanders through an evidence-based approach adapted for a broader audience and utilize  technology to effectively implement bullying prevention.

Phase II Specific Aims

  • Develop a fully-programmed, media-rich, interactive STAC-T intervention in English and Spanish consisting of (1) core modules providing interactive training on essential topics (such as bullying, bystander roles, STAC strategies), (2) interactive skills practice with avatars moving through bullying scenarios with feedback, and (3) booster sessions in which students report strategy use and feedback and badges for intervening.
  • Conduct usability testing of the fully-programmed STAC-T in three middle schools in two states with students and school personnel to evaluate the user interface, ease of use, and perceived barriers in order to optimize the program prior to a large-scale investigation.
  • Test the fully-programmed, dual language (English and Spanish) STAC-T in six middle schools in four states through a randomized controlled trial to evaluate changes in (1) knowledge, confidence, and use of STAC strategies, (2) bullying and cyberbullying perpetration and victimization, and (3) mental health outcomes.

The investigators hypothesize that STAC-T will (1) improve access by reducing implementation barriers for middle schools, particularly those in rural and low-income communities, (2) train bystanders to effectively intervene, reducing bullying while simultaneously improving the mental health of bystanders, and (3) improve program sustainability at the middle school level when bullying behavior peaks.

The STAC-T project is funded by an STTR Phase II grant to Klein Buendel from the National Institute on Minority Health and Health Disparities at the National Institutes of Health (MD014943; Dr. Aida Midgett, Principal Investigator). Dr. Midgett is a Professor and Chair of the Department of Counselor Education at Boise State University. Her collaborators on this research project include Dr. Diana Doumas and Dr. Laura Bond from Boise State University; Dr. Robin Hausheer from Plymouth State University; Dr. Amanda Winburn from the University of Mississippi; and Ms. Mary Buller from Klein Buendel. The STAC-T modules will be programmed by Klein Buendel’s Creative Team.

Responsible Beverage Service Training for Spanish-Speaking Alcohol Servers

Responsible Beverage Service Training for Spanish-Speaking Alcohol Servers

Responsible Beverage Service (RBS) training has shown promise to reduce alcohol-related injury and mortality. The diffusion of RBS training is limited. Only 25 U.S. states require RBS training, while other states incentivize or have no RBS regulations. One diffusion limitation is that RBS training in the United Stated is typically offered in English from a mainstream culture point of view. 

Klein Buendel Senior Scientist, Dr. W. Gill Woodall, presented data on the systematic testing of a new Spanish language version of an evidence-based online RBS training program at the 47th Annual Meeting of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol, May 30 to June 3, 2022 in Warsaw, Poland. WayToServe Español (WTS-E) is specifically tailored to Hispanic cultural beliefs, tastes, and experiences.

Spanish-speaking alcohol servers in Texas and New Mexico were involved in WTS-E development and evaluation. Focus groups and usability interviews were employed in systematic development. A randomized efficacy trial employed Spanish-speaking intoxicated pseudo-patron assessments of premises at baseline, 3 months, and 1 year post-training, with premises randomized to WTS-E or the usual RBS training. 

A randomized trial was conducted with 80 alcohol premises (40 onsite liquor by the drink premises, and 40 offsite package sales premises), with pseudo-intoxicated patron assessments at baseline, immediate post-intervention, and one-year follow-up. At baseline, the alcohol sales refusal was 21.6%, with a significant difference between states. The presentation examined the impact of a linguistically- and culturally-tailored online RBS training in Spanish-trading alcohol premises in two states with different alcohol RBS regulations. Implications for alcohol policy research were discussed.

The WTS-E research was funded by a grant from the National Institute on Minority Health and Health Disparities at the National Institutes of Health (MD010405; Dr. W. Gill Woodall, Principal Investigator). Collaborating co-authors on the presentation included Dr. Robert Saltz from the Pacific Institute for Research and Evaluation; Dr. Frank Perez and Dr. Areli Chacon Silva from the University of Texas at El Paso; Dr. Victoria Sanchez and Dr. Randall Starling from the University of New Mexico; and Dr. David Buller, Jeannyfer Camacho Reither, Lila Martinez, and Marita Brooks from Klein Buendel.