Positive parenting practices help support optimal child social and emotional development. Parent training is considered a gold standard for supporting and strengthening parenting practices and for treating and preventing child behavior problems. A new research grant awarded to Klein Buendel will develop and test a comprehensive implementation package (the ezParent Bundle) to support the hybrid delivery of the ezParent Program.
Klein Buendel Research Investigator, Ms. Julia Berteletti, and the Klein Buendel Creative Team are collaborating with Dr. Susan Breitenstein from Ohio State University (Principal Investigator) on the project. ezParent is the web-based delivery mechanism of the Chicago Parent Program. ezParent integrates empirically supported parenting strategies and includes video vignettes, interactive activities, and in-home practice. The new bundle will include asynchronous web-based facilitator training and the ezParent dashboard, which allows facilitators to track parent program use and offer support.
Young children’s behavioral health is declining with current estimates of up to one-third of preschool children exhibiting behavior problems (such as tantrums, defiance, and aggression). Behavior problems have been more pronounced in minoritized and low-income populations and because of the COVID-19 pandemic. Positive and supportive parenting can buffer the negative effects of early adverse experiences and childhood trauma.
The primary method of delivering parent training involves face-to-face, in-person sessions. Although effective, there are multiple limitations with in-person parent training delivery affecting access and reach (such as time; schedule conflicts; access to childcare, transportation, trained facilitators; and stigma). These barriers result in many referred parents not receiving parent training. Parent completion access issues are more pronounced in underserved communities. An overall goal of this research is to expand parent training access in community organizations dedicated to serving low-income families [such as Head Start and Early Head Start (HS/EHS)].
Many web-based parent training programs are self-administered, yet there is evidence suggesting web-based programs are more effective when paired with human support, known as hybrid delivery. Trained facilitators can foster parent completion of web-based programs and tailoring of strategies. However, parent training programs lack a proven method for systematically integrating facilitator training in an accessible manner. In addition, for hybrid models to be effective, facilitators require methods to monitor and track parent use of the program. Real-time access to training can increase program sustainability and user tracking allows support to be tailored based on parent program use and individual needs.
The ezParent bundle will be evaluated in a cluster randomized trial in 16 HS/EHS sites with personnel facilitators and 516 parents of children aged 2-5 years old. The investigators hypothesize that relative to the control group, parents in the ezParent bundle group will report greater improvements in parenting skills and self-efficacy, parent-child relationship, and reductions in child behavior problems.
This STTR Fast Track grant was awarded to Klein Buendel by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD116627; Dr. Susan Breitenstein, Principal Investigator from Ohio State University). Research collaborators include Ms. Julia Berteletti from Klein Buendel, and Dr. Amie Bettencourt and Dr. Deborah Gross from Johns Hopkins University. The ezParent technology will be designed and programmed by the Creative Team at Klein Buendel.
6th International Conference on UV and Skin Cancer Prevention: Posters
Klein Buendel research investigators and staff presented three posters on their skin cancer prevention research at the 6th International Conference on UV and Skin Cancer Prevention in Brisbane, Queensland, Australia, September 10-13, 2024.
Poster 1 – This poster won a BEST POSTER AWARD at the conference.
Title: Narrative Synthesis of Skin Cancer Prevention Interventions for Samples with High Proportions of Participants with Skin of Color in a Systematic Review
Presenter: Irene Adjei, BS
Authors: David Buller, PhD; Alexandra Morshed, PhD; Radhika Agarwal, MPH; Irene Adjei, BS; Shenita Peterson, MPH; Cam Escoffery, PhD; Mary Buller, MA; Barbara Walkosz, PhD; Kayla Anderson, MPH
While melanoma and keratinocyte skin cancers are very prevalent in light-skinned non-Hispanic (NH) White adults in the United States, rates of skin cancer may be increasing in Hispanics, African Americans present with thicker lesions, and both Hispanics and African Americans have higher skin cancer mortality rates than NH Whites. Ethnic minority adults may have lower knowledge and risk perceptions, practice sun protection infrequently and for reasons other than skin cancer, have less access to dermatologists, and receive fewer skin exams than NH Whites. As part of a project adapting an evidence-based occupational program to be more equitable by including lower-risk African American and Hispanic worker populations, investigators conducted a systematic literature review of 25 behavioral skin cancer prevention interventions. Investigators extracted information from 10 studies (2014-2022) that evaluated interventions in samples with 20% Hispanic and/or African American participants. Interventions were delivered in eight clinical and two community settings through verbal (for example, a community health worker), printed, visual (for example, videos/photographs), and e-messages. Adaptations for individuals with skin of color included incorporating culturally relevant images, culturally appropriate language (including Spanish translation), and testimonials, informed by diverse research staff and interested individuals. Seven studies evaluated interventions in randomized controlled trials, two in non-randomized experimental designs, and one in a cohort study, with interventions primarily showing improvements in knowledge, perceived risk, and reported sun protection. To be effective with lower-risk populations, skin cancer prevention interventions should incorporate cultural tailoring of images, language, and testimonials. This research was funded by a grant from the Centers for Disease Control and Prevention (U48DP006377; Alexandra Morshed and David Buller, Multiple Principal Investigators).
Poster 2
Title: Feasibility of Using Location-Based Data through the Strava App to Provide Tailored Sun Protection Advice to Outdoor Exercisers
Presenter: Alishia Kinsey, BS
Authors: Alishia Kinsey, BS; Julia Berteletti, MSW; David Buller, PhD; Chuck Anderson, PhD; Kimberly Henry, PhD
Individuals who engage in more physical activity have a higher prevalence of sunburn, and melanoma is positively associated with physical activity. This study was designed to determine the feasibility of using Strava, a popular exercise tracking app, to promote sun protection tailored to individuals who engage regularly in outdoor physical activity. To provide tailored sun protection advice, investigators connected through the Strava Application Programming Interface (API) to collect retrospective activity data from users who consented and authorized collection of data from the past two years. Despite robust recruitment efforts, only 78 Strava users provided this authorization. From these users, 16,669 outdoor activity events were accessed. Of those activities, 46.1% occurred during high UV (between 10 am and 4 pm) for at least 30 minutes. Using predictive modeling, time outdoors for more than one hour during high UV was predicted by day of week (more likely occurs on weekends) or proximity to a high UV event (less likely occurs the day after a previous high UV event). While Strava users are active and prone to overexposure to the sun, privacy settings in the Strava app, which became more restrictive during the study, and users’ resistance to share their data were substantial barriers to employing the app to deliver tailored advice on sun safety. It may be possible to predict when exercisers would be outside during high UV periods if periodicity of individuals’ exercise bouts are known (information that users might be willing to disclose in a mobile app without sharing location data). This research was funded by a grant from the National Cancer Institute (CA241637; Dr. David Buller and Ms. Julia Berteletti, Multiple Principal Investigators).
Poster 3
Title: Gender Differences in the Sun Safety Practices of Tattoo Studio Clients
Presenter: Mary Buller, MA
Authors: Barbara Walkosz, PhD; Mary Buller, MA; David Buller, PhD; Robert Dellavalle, MPH, MD
Melanoma is the one of the most common cancers among young adults and low rates of sun protection are elevated in this group. Approximately 225 million people worldwide have tattoos and 40% of adults ages 18-29 have at least one tattoo. The Sun Safety Ink! program trained tattoo artists to promote full-body comprehensive sun protection to clients to compliment standard aftercare instructions that recommend sun protection for new tattoos. Thirty-seven tattoo studios participated. At pretest, 861 clients completed an online survey and self-reported sun protection on a 5-point scale as: apply sunscreen SPF 15+ on face (aftershave, face lotion, or make-up); apply sunscreen SPF 30+ exposed skin areas; reapply sunscreen; apply sunscreen lip balm; wear any hat; wear wide-brimmed hat; wear sunglasses; stay mostly in the shade; wear protective clothing; watch skin for sunburn or tanning. Women were significantly more likely to apply sunscreen of SPF 15+ on the face, apply sunscreen of SPF 30+ to exposed skin, reapply sunscreen every two hours, limit time in the sun, and watch their skin for signs of sunburn. Men were significantly more likely to wear any hat and a brimmed hat. Strategies are needed to promote specific sun protection practices for men and women as these reported practices have remained persistent. This research was funded by a grant from the National Cancer Institute (CA206569; Barbara Walkosz and Robert Dellavalle, Multiple Principal Investigators).
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Klein Buendel investigators and staff were collaborators on two additional skin cancer prevention research posters at the UV and Skin Cancer Prevention conference.
Poster 4
Title: Indoor Tanning Facility Regulation Compliance in the United States Remains Suboptimal: A Confederate Study
Presenter: Carolyn Heckman, PhD
Authors: Carolyn Heckman, PhD; Anna Mitarotondo; Melissa Goldstein, MS; Rucha Janodia; Ileana Gonzalez; Julia Berteletti, MSW; David Buller, PhD
In the United States, indoor tanning is regulated by the Food and Drug Administration (FDA) and individual state legislation. Twenty-two states and the District of Columbia ban minors under age 18 from indoor tanning, 22 have varying age restrictions and parental involvement requirements, and six have no age restrictions. This study assesses law compliance of indoor tanning facilities, hypothesized to be insufficient and inconsistent. Trained female staff pseudo-patrons called indoor tanning facilities (such as indoor tanning salons, beauty salons/spas, gyms, apartments) posing as minors one year younger than the state’s permitted age to tan (for example, 17 in a state banning indoor tanning under age 18). Pseudo-patrons asked about unlimited indoor tanning packages (contrary to FDA recommendations), sunburns, and whether they were permitted to indoor tan. One hundred and twelve (112) calls were completed across 15 states. Twenty-one percent of facility staff did not ask pseudo-patrons for their age, and 41% told pseudo-patrons they could indoor tan despite being underage. Forty-one percent (41%) of gyms/apartments did not require pseudo-patrons to be a member/tenant to indoor tan. Eight-one percent (81%) of facilities offered unlimited indoor tanning packages or unlimited access during open hours, and 29% of staff did not admit to pseudo-patrons that they could be sunburned from indoor tanning. Although many state laws restricting indoor tanning have been passed in the United States, and indoor tanning has decreased, facilities continue to be non-compliant with restrictions for minors, putting children at risk of sunburns and skin cancer. Further analyses will evaluate compliance by type of facility, law stringency, and U.S. region. This research was supported by a grant from the National Cancer Institute (CA244370; Carolyn Heckman and David Buller, Multiple Principal Investigators).
Poster 5
Title: Adolescents’ Perceived Threat and Perceived Efficacy in Relation to Skin Cancer: Associations with Tanning, Sunburns, and Sun Protection
Presenter: Tammy Stump, PhD
Authors: Tammy Stump, PhD; Jennifer Hay, PhD; Kenneth Tercyak, PhD; David Buller, PhD; Douglas Grossman PhD, MD; Jacob Jensen, PhD; Jincheng Shen, PhD; Yelena Wu, PhD
According to the Extended Parallel Process Model (EPPM), health promotion programs are optimally successful when they heighten the perceived threat of a medical condition while also enhancing perceived efficacy for offsetting that threat. For skin cancer prevention, the authors developed a school-based intervention based on EPPM constructs. The program was designed to both enhance perceived threat of skin cancer (such as susceptibility, severity) and perceived efficacy for sun protection (such as self-efficacy, response efficacy). In advance of the intervention, 2,199 participants (52% female) at 36 Utah high schools completed a baseline survey, which was analyzed as an initial test of the conceptual model underlying the intervention approach. Within a series of linear regression models, all four EPPM constructs were simultaneously entered as independent variables. Self-reported sun protection, tanning (intentional, outdoor, and unintentional), and sunburns served as dependent variables. In these models, self-efficacy significantly predicted all outcomes. Response efficacy for sun protection was associated with greater weekend sun protection. Susceptibility to skin cancer was significantly associated with all outcomes except indoor tanning. Severity of skin cancer was significantly associated with sun protection use only. In sum, self-efficacy was the strongest predictor of outcomes whereas perceived severity of skin cancer had a small effect, and only on one outcome. Overall, these findings suggest that by targeting EPPM constructs, the intervention is likely to have an effect on adolescents’ tanning, sunburns, and sun protection behaviors. This research is sponsored by the National Cancer Institute (Dr. Yelena Wu from the University of Utah and the Huntsman Cancer Institute, Principal Investigator).
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.
WayToServe®, an evidence-based online responsible alcohol server training program, has sold its 100,000th training!
WayToServe was created by scientists and developers from the University of New Mexico, the Pacific Institute for Research and Evaluation, and Klein Buendel. The engaging, media-rich program was initially evaluated in a controlled randomized trial that resulted in high trainee satisfaction and increased refusal of sales to intoxicated patrons. WayToServe was licensed to Wedge Communications, LLC and launched into the online marketplace in 2012. To date, WayToServe has been tailored and approved for sale and certification of trainers in California, Texas, Washington, and New Mexico.
To meet the needs of Spanish-speakers, Klein Buendel is currently testing a companion program, WayToServe Español. “WayToServe Español es muy importante! It could help saves lives,” said Dr. W. Gill Woodall, the project’s director. The unique Spanish-language training program will be on the market in 2021.
The original WayToServe program was funded by two grants from National Institute on Alcohol Abuse and Alcoholism to the University of New Mexico (AA014982 and AA016606; Dr. W. Gill Woodall, Principal Investigator). The WayToServeEspañol program is funded by a grant from the National Institute of Minority Health and Health Disparities (MD010405; Dr. W. Gill Woodall, KB Senior Scientist, Principal Investigator).
Three Klein Buendel researchers were part of a
team that gave two presentations at the Tenth European Society for Prevention
Research (EUSPR) Conference and Members’ Meeting in Ghent, Belgium in September.
Dr. David Buller, Dr. W. Gill Woodall, and Ms. Julia Berteletti were part of
the Smart Choices 4 Teens research team led by Dr. Brenda Miller from the
Prevention Research Center at the Pacific Institute for Research and Evaluation
(PIRE).
Smart Choices 4 Teens is an online,
interactive, family-based program for parents and older teens designed to
reduce teen alcohol use and risky sexual behaviors. The program features three
sequential components (parent-teen communication, teen alcohol prevention, and
teen romantic relationships) that parents and teens complete separately before
working together through a discussion activity at the end of each component. A randomized
controlled trial with 411 families found significantly better outcomes for
teens in the experimental condition as compared to controls in terms of
decreased alcohol use and decreased sexual risk behaviors.
Oral
Presentation
Dr. Brenda Miller’s presentation focused on the
design of the Smart Choices 4 Teens alcohol prevention component. This module targeted
eleven topics: (1) the decision to drink or not drink, (2) social host laws,
(3) physical effects of alcohol, (4) signs of alcohol poisoning, (5) social
consequences of alcohol, (6) an interactive Blood Alcohol Calculator, (7) myths
about alcohol, (8) creating a safety plan for parties, (9) parental influences,
(10) refusal skills, and (11) defining a drinking problem. The module
incorporated four different activity formats — video narratives, info-gadgets,
interactive activities, and structured discussions. Parents and teens engaged
in the same materials but did so separately, coming together to choose and
discuss hypothetical scenarios that guided the discussion offline. A “nudge”
feature was embedded to allow teens to prompt their parent to finish a module
and move to the end-of-module offline discussion or vice versa. The nudge
feature was used 561 times by 218 users.
Dr. Miller reported that 86% of experimental
families began the intervention and 50% of families completed the teen alcohol prevention
component. The average time needed to complete the alcohol component was 16
minutes. Parents and teens reported learning new lessons and becoming more
comfortable discussing alcohol use together. Barriers to completion included limited
understanding of some content and needing additional instructions.
Poster
Presentation
Dr. David Buller presented a poster, with
analysis led by Dr. W. Gill Woodall, on the effect of teen engagement with Smart Choices 4 Teens. Teens and
parents (411 dyads) completed an online baseline survey prior to being assigned
to either the intervention or control conditions. Follow-up online surveys were
completed 6, 12, and 18 months later. The teen sample was 55% female and 72%
non-Hispanic White. The parent sample was comprised predominately of mothers
(84.7%).
The Smart Choices 4 Teens website tracked
duration of time spent using each of the web-based components. In an analysis
of teens who completed the program in the intervention group (n=142), linear
regressions tested duration of teens’ time in each online component in the
entire program as predictors of teens’ past 30-day alcohol use at the 6-month
follow-up. More time spent by
teens using interactive activities negatively predicted later alcohol use, as
did teens’ time spent viewing videos. Also, teens’ time spent using info-gadget
activities had a negative relationship with alcohol use.
The researchers report that activities with
interactivity, animations, and video content may produce stronger preventive
effects on alcohol use because teens prefer this format over written text in
the info-gadgets, have more involvement with them, and/or find characters
relatable. These reactions may stimulate deep processing of prevention content.
The Smart Choices 4 Teens research was
supported by a grant from the National Institute on Alcohol Abuse and
Alcoholism (AA020977; Dr. Brenda Miller, PIRE, Principal Investigator). Other
authors on Dr. Miller’s research team included Dr. Hilary Byrnes, Ms. Veronica
Rogers, and Dr. Joel Grube from PIRE; Dr. Beth Bourdeau from the University of
California San Francisco; and Dr. David Buller, Dr. W. Gill Woodall, and Ms.
Julia Berteletti from Klein Buendel. Smart Choices 4 Teens was programmed by
the Creative Team at Klein Buendel.
Klein Buendel has licensed its online responsible vendor training program for recreational marijuana stores, Train To Tend®, to Avid Will LLC for sales and marketing. Senior Scientists, Dr. David Buller and Dr. W. Gill Woodall, and their collaborators created Train To Tend to provide retail staff with knowledge and skills to sell recreational marijuana responsibly in an effort to keep their communities safe. Avid Will LLC will make Train to Tend available immediately to retail recreational marijuana stores in Colorado. State-specific versions for Oregon, Washington State, Massachusetts, and California will be launched this year, as well.
In 2017 and
2018, Train To Tend 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 the
Train To Tend training while the remaining stores received the usual and
customary training in their state. Post-training surveys were administered to
Train To Tend trainees to gauge their perceptions of self-efficacy toward responsible
vending practices, as well as their ratings of usability for Train To Tend.
The training
improved trainees’ ability to check IDs, and their confidence in using their
state’s inventory tracking system and identifying intoxicated customers. Trainees
rated the training as user-friendly and thought that the information and skills
learned in the training would help keep their communities safe. In a recent
review, Danielle, an Instructional Designer for Native Roots, a Colorado retail
chain, said “Train To Tend has been effective and engaging for our employees,
and we are thankful for the Train To Tend team and their online responsible vendor
program.”
The
development and evaluation of Train to Tend was funded by a grant from the
National Institute on Drug Abuse at the National Institutes of Health (DA038933;
Dr. David Buller, Principal Investigator). Additional scientific collaborators
include Dr. W. Gill Woodall from Klein Buendel and Dr. Robert Saltz from the
Pacific Institute for Research and Evaluation in California.
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.
