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Perception of Physical Activity Leaderboards

Perception of Physical Activity Leaderboards

Digital health tools to promote physical activity frequently incorporate leaderboards, to encourage physical activity by activating social comparison processes (self-evaluation relative to others). However, the acceptability and utility of leaderboards to the general population remain unclear.

Dr. Kayla Nuss, Klein Buendel Scientist, collaborated on a set of research studies led by Rowan University to compare leaderboard display formats and their relationship to physical activity motivation. The significance, methods, analysis, and findings of the two studies are detailed in the journal Digital Health.

One hundred forty-five (145) young adults from the United States (Study 1) and 1,510 adults from Germany and Austria (Study 2) evaluated two common leaderboard display formats and provided explanations for preferences. Participants also reported their physical activity motivation following exposure to fixed (Study 1) or randomized (Study 2) leaderboard placements. Open-ended responses were analyzed using content analysis and sentiment analysis in Python.

Familiarity with leaderboards was low (Study 1: 43%; Study 2: 19%) and display preferences varied. Approximately 43-49% across both studies reported high physical activity motivation post-leaderboard exposure. Both analytic methods showed that these participants subsequently expressed a range of perceptions of physical activity leaderboards (positive, negative, and neutral). Further, ∼21% of each sample reported low motivation for physical activity after exposure, yet their perceptions ranged from rejecting competitive comparisons to recognizing that leaderboards could benefit others. Sentiment analysis further revealed that participants who reported no display preference expressed the most negative sentiment, regardless of their motivation.

Findings demonstrate considerable heterogeneity in adults’ perceptions of physical activity leaderboards, even among those who experience high motivation for physical activity following leaderboard exposure. Because a single ideal format may not meet all users’ needs, personalized designs that account for individual factors may better support long-term engagement with digital health tools and sustained physical activity.

This research was supported by an NIH Director’s New Innovator Award (HL173857; Dr. Danielle Arigo, Principal Investigator) and Klein Buendel. Collaborators include Ninelle Edenne, Raj Harsora, Angelica Rivera, and Dr. Danielle Arigo from Rowan University; Dr. Laura Konig from the University of Vienna; and Dr. Kayla Nuss from Klein Buendel.

Launch of the Momentum+ Project

Launch of the Momentum+ Project

Dr. Kayla Nuss, Klein Buendel Scientist, has launched a new research project to develop and assess a prototype of the Momentum+ physical activity app for older cancer survivors. The app will leverage the staircase method, a progressive, incremental goal-setting framework, and is grounded in self-determination theory, which emphasizes autonomy, competence, and relatedness as essential drivers of sustained behavior change. 

In the United States, nearly 80% of cancer survivors are aged 60 or older. Older cancer survivors are at increased risk for cancer recurrence, co-morbidities, and reduced quality of life, in part due to insufficient physical activity and high levels of sedentary behavior. Despite strong evidence linking physical activity engagement and sedentary behavior reduction to improved health outcomes, few scalable, theory-driven mobile health solutions exist that are specifically designed for older cancer survivors.

An initial list of planned Momentum+ app components includes: integrated wearable activity tracker (Fitbit) data, progressive activity promotion plans, personalized activity prompts, weekly summaries and aggregated feedback, options for rest weeks to account for illness fatigue, or travel, exercise instructional videos appropriate for older cancer survivors, a caregiver/family member portal, and features optimized for older adults, including large fonts, and simple navigation.

A varied sample of 32 older cancer survivors (age 65 years and older) will review the app concept (interest in the app, desired components) in focus groups. Once 70% of focus group participants express a desire for the app, the research team will develop an interactive prototype of the mobile app. The prototype will be usability tested by 10 older cancer survivors to assess navigation, clarity, satisfaction, and functionality. The team will use a validated scale, the System Usability Scale, to collect quantitative data on prototype usability. 

The primary Phase I outcomes will include app acceptability, and prototype usability ratings, as well as qualitative feedback on design and content. Successful completion of Phase I will yield a user-informed, functionally tested prototype of Momentum+, ready for refinement, full development, and extensive testing against a commercially available physical activity app in a Phase II project. If proven effective in a future Phase II project, Momentum+ has the potential for broad dissemination as a scalable, evidence-based tool to promote physical activity, reduce sedentary behavior, and improve health outcomes in older cancer survivors.

This research is sponsored by a Phase I SBIR grant from the Centers for Disease Control and Prevention (DP006972; Dr. Kayla Nuss, Principal Investigator). Dr. Nuss’s collaborators include Dr. Dori Rosenberg from Kaiser Permanente and Dr. Heather Leach from Colorado State University. The Momentum+ app will be developed by the Klein Buendel Creative Team.

Body Neutrality Workbook to Increase Physical Activity

Body Neutrality Workbook to Increase Physical Activity

Dr. Kayla Nuss, Klein Buendel Scientist, and her research team have published the results of a pilot study on the use of a body neutrality workbook intervention to improve physical activity and motivation in insufficiently active women. The paper has been published online ahead of print in the American Journal of Lifestyle Medicine, a Sage publication.

Nearly half of adult women in the United States do not meet recommended levels of moderate-to-vigorous physical activity (MVPA), despite well-established health benefits. Sociocultural pressures emphasizing thinness and appearance may promote controlled, appearance-based motivation for physical activity, a motivational orientation that has been associated with less sustained engagement.

This pilot study examined whether a 6-week, self-guided body neutrality workbook intervention was associated with changes in MVPA and psychological mediators of physical activity among insufficiently active adult women. Body neutrality shifts attention away from physical appearance and toward body functionality, self-care, and self-worth independent of body size. The workbook uses daily exercises, journaling, and reflection prompts to foster self-acceptance. Instead of forcing body positivity or loving one’s appearance, the guide teaches the user to view their body as a neutral vessel focused on function and respect.

Twenty participants who did not meet physical activity guidelines at baseline completed pre- and post-intervention assessments of MVPA, motivation, basic psychological needs, body image constructs, and physical intentions and planning. Results indicated a moderate increase in MVPA. Improvements were also observed in autonomy, competence, intrinsic and integrated motivation, body functionality appreciation, body compassion, and physical intentions and planning, alongside reductions in introjected regulation and appearance-based social comparison.

The findings suggest that a body neutrality approach may support more autonomous motivation for physical activity. Although limited by small sample size and lack of a control group, this study provides preliminary evidence that body neutrality-based interventions may represent a promising, scalable strategy to promote both psychological well-being and physical activity engagement among adult women. Research significance, intervention methods, data collection and analysis, and conclusions are detailed in the American Journal of Lifestyle Medicine paper.

This research was sponsored by Klein Buendel and led by Dr. Kayla Nuss, in collaboration with Ms. Anne Poirier from Shaping Perspective LLC. Shaping Perspectives is a women’s wellness education and coaching company that specializes in body image, body neutrality, intuitive eating, and sustainable health behavior change. Ms. Poirier is a Certified Intuitive Eating Counselor, Eating Disorder Specialist, and author. She has authored three best-selling books and has three more publishing this year, including the second, expanded edition of her seminal work, The Body Joyful.  

KB Research Presented at SBM

KB Research Presented at SBM

Klein Buendel researchers, Dr. Kayla Nuss and Ms. Julia Berteletti, and their collaborators presented two novel posters at the 47th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM) in Chicago, IL on April 22-25, 2026.  

*Klein Buendel authors are bolded.

POSTER 1 

Title: Applying Body Neutrality Principles to Physical Activity Promotion: A Pilot Test of the Body Neutrality Playbook 

Presenter: Dr. Kayla Nuss 

Collaborators: Anne Poirier, Amanda Brice, Sierra Held, Taylor Sullivan, Noah Chirico

This pilot study examined preliminary effects of the Body Neutrality Playbook on physical activity behavior, Self-determination Theory (SDT) motivation, and body image–related constructs in women insufficiently active at baseline. 

Body image concerns and weight stigma can undermine motivation for physical activity, particularly among women not meeting public health recommendations. The Body Neutrality Playbook is a six-week, self-guided workbook grounded in body neutrality principles, designed to promote sustainable physical activity by fostering autonomous motivation, self-compassion, and body appreciation while reducing harmful appearance-based cognitions. 

Twenty adult women completed the Body Neutrality Playbook over six weeks. Measures were collected at baseline and post-intervention, including self-reported weekly minutes of moderate-to-vigorous physical activity (MVPA), physical activity intention, physical activity planning, SDT-based motivation (intrinsic, integrated, identified, introjected, external), basic psychological needs satisfaction (competence, autonomy, relatedness), body functionality appreciation, body compassion (body kindness, motivated action, common humanity), internalized weight bias, and physical appearance comparison. Analyses examined mean change scores and Cohen’s d effect sizes to assess preliminary intervention impact. 

Post-intervention, participants demonstrated meaningful increases in MVPA minutes per week, physical activity intention, and physical activity planning. SDT outcomes showed increased competence and autonomy, decreased introjected regulation, and increased integrated regulation and intrinsic motivation. Body image–related outcomes indicated increases in body appreciation, decreases in physical appearance comparison, and improvements in two of three body compassion subscales (body kindness and motivated action). Effect sizes for these changes were in the small-to-large range, suggesting practical significance despite the small sample. 

Preliminary findings suggest the Body Neutrality Playbook may promote both autonomous physical activity motivation and positive body image while reducing appearance-based self-comparisons among women who are insufficiently active. The combination of body neutrality principles and SDT-informed behavior change strategies may address both psychological and behavioral barriers to physical activity. Future research with larger, more diverse samples and a controlled design is warranted to evaluate efficacy and mechanisms of change. 

This research was sponsored by Klein Buendel and led by Dr. Kayla Nuss. Anne Poirier is from Shaping Perspectives.

POSTER 2 

Title: Delivering online parent training program usage data in real-time: the iterative development of an administrative dashboard  

Presenter: Julia Berteletti 

Collaborators: Dr. Susie Breitenstein, Dr. Nathan Helsabeck, Dr. Kayla Herbell, Charlie Barger, Alishia Kinsey 

Julia Berteletti

Online parent training programs help strengthen parent-child relationships by providing parents with practical knowledge and evidence-based strategies for managing child behavior. In a hybrid parent training model, facilitators engage with parents while parents complete online modules. Administrative dashboards offer an integrated platform for program staff (administrators, facilitators, researchers) to track parent progress and activity in online parent training modules in real time. 

The research team iteratively developed and tested an administrative data delivery dashboard of the online ezParent Parent Training program. Using a single-group design with administrators and facilitators who deliver ezParent, 15 participants spent 30 minutes reviewing the ezDashboard and completed a survey about their experience. The survey included the validated 10-item System Usability Scale (SUS) and open-ended questions focusing on navigation ease and overall usefulness of the ezDashboard. Following the usability testing, we made additional refinements (adding exportable reports) to the dashboard. Based on feedback from an Expert Advisory Board (EAB) made of experts in community programming and parent training delivery, we also created a new metric, the Engagement Index, to measure and summarize parent participation within modules to provide facilitators with insights into how parents used the program. The EAB reviewed the revised dashboard and completed the SUS survey. Final refinements have been completed. 

In the initial usability testing, participants indicated high usability of the ezDashboard with a total mean SUS score of 83.5. Most participants (n=13, 87%) rated the overall user-friendliness of the ezDashboard as good (n=3, 20%), excellent (n=9, 60%), or best imaginable (n=1, 7%).  Open-ended questions showed the ezDashboard is or would be useful to monitor parent progress and trends in engagement (n=8, 53%). To facilitate that, we created the Engagement Index (0-100% per module) to assist facilitators’ understanding of how parents interact with ezParent. After revisions, the EAB rated the ezDashboard as 83.6. 

Results from iterative testing indicate that the ezDashboard is easy to use and provides functional information to those delivering ezParent.  Next, the ezDashboard will be used in a randomized controlled trial testing hybrid delivery of ezParent. The usefulness of the Engagement Index as a more robust measure of program use will be assessed.  

This STTR 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 Julia Berteletti from Klein Buendel, and Dr. Amie Bettencourt and Dr. Deborah Gross from Johns Hopkins University.

The ezParent technology was designed and programmed by the Creative Team at Klein Buendel. 

Collaborator Spotlight:
Ms. Anne Poirier

Collaborator Spotlight:
Ms. Anne Poirier

Meet Klein Buendel’s newest research collaborator, Ms. Anne Poirier. She is the originator of the concept of body neutrality, which helps people step away from dieting and redefine their relationships with eating, their bodies, and themselves.

Ms. Poirier is the owner of a body neutrality coaching company and the author of books about self-care and compassion. She graduated from Plymouth State University with a bachelors’ degree in exercise science. She is also a graduate of the Eating Disorder Institute at Plymouth State University and the Life Coach Institute. She is an intuitive eating counselor, a self-talk trainer, and an NSCA-CSCS strength and conditioning specialist. She also serves on the National Eating Disorders Association Lived Experience Task Force.

Ms. Poirier is a nationally recognized body image expert and the author of The Body Joyful and Not a Fat Annie. She is a pioneer and leading voice for the body neutrality movement and has been featured and cited in major media outlets around the word including Shape, Women’s Health, New York Times, Washington Post, Newsy, Livestrong, ABC, and NPR. She is a long-time eating disorder survivor and certified self-talk trainer. She has been a guest on more than 50 podcasts. In 2015, she founded the company Shaping Perspectives…A Woman’s Way to Joy. The cornerstone of the company is the Body Joyful Solution, a coaching program based on the principles of body neutrality.

As her mission is to reduce bullying, body shaming, weight stigma, and eating disorders for the next generation, Ms. Poirier is collaborating with Klein Buendel Scientist, Dr. Kayla Nuss, on NoWeigh!, a novel approach to weight management. The NoWeigh approach emphasizes gratitude for the body’s function, a neutral attitude about the body’s appearance, and engagement in movement that is enjoyable, rather than weight loss. The NoWeigh! Project is funded by an SBIR grant from the National Institute of Diabetes, Digestive and Kidney Diseases (DK142209; Dr. Kayla Nuss, Principal Investigator).

MobileMen and mHealth

MobileMen and mHealth

Ms. Amanda Brice, Klein Buendel Project Coordinator, is the lead author on a research paper published in the journal mHealth. The paper reports on the development of MobileMen, a mobile app to promote physical activity in African American men.

African American men experience higher rates of chronic diseases including diabetes, cardiovascular disease, and obesity compared to other race and gender groups. This population also has high levels of inactivity, one of the major risk facts for chronic disease. Due to the promise shown by mobile apps in providing tailored and easily accessible health interventions, the authors set out to design an app to help African American men initiate and maintain their physical activity.

The research team conducted focus groups with 24 African American men to gain insight on the features and design aspects to include in the app prototype. They then used an iterative design process to conduct multiple rounds of beta and usability testing to create a prototype that was easy to use, visually pleasing, and culturally tailored. A satisfaction and helpfulness questionnaire and the System Usability Scale (SUS) were used as quantitative measures in addition to qualitative data provided by participants. Tasks were given to participants to test for ability to navigate and use the app features.

The average satisfaction and helpfulness ratings from participants were 3.9/5 and 3.7/5 for beta testing and 4.3/5 and 4.1/5 for usability testing, which met the pre-determined criteria of ≥3.5. Only one of the satisfaction questions, which was about cultural tailoring for African American men, was below the pre-determined criteria (2.7). By round two of usability testing, most tasks were able to be completed by all participants, and the mean SUS score was 90.36 out of 100 which exceeded a priori feasibility criterion of a mean rating of 68.0. The feedback on the finalized features was positive, and participants expressed that they would use the app if it were on the market.

Based on both the qualitative and quantitative data obtained from multiple iterative design rounds, the MobileMen app was easy to use and contained culturally tailored features. It was well received by the target population and deemed ready to be tested on a larger scale for effectiveness. Full descriptions of the methods, analyses, and findings can be found in the mHealth paper.

This research is funded by an STTR Fast Track grant to Klein Buendel from the National Institute on Minority Health and Health Disparities (MD014947). The Principal Investigator is Dr. Robert Newton from the Pennington Biomedical Research Center. Authors on this paper include Amanda Brice, Steve Fullmer, Charles Barger, Joel Serbinski, Michael Gallik, Dr. David Buller, and Dr. Kayla Nuss from Klein Buendel; Phillip Nauta, and Dr. Robert Newton from the Pennington Biomedical Research Center; Dr. April Stull from Baylor University; Dr. Damon Swift from the University of Virginia; and Dr. Derek Griffith from the University of Pennsylvania. The MobileMen app was designed and programmed by the Klein Buendel Creative Team.

No Weigh!

No Weigh!

Klein Buendel Scientist, Dr. Kayla Nuss, has launched a new research project, funded by the National Institute of Diabetes, Digestive and Kidney Diseases. It will test a novel approach to physical activity promotion. The proposed intervention, NoWeigh!, is a mobile app based on a framework called body neutrality. Body neutrality emphasizes gratitude for the body’s function, a neutral attitude about the body’s appearance, and engagement in movement that is enjoyable, rather than weight loss.

Obesity rates are on the rise in the United States. Weight loss has been the primary recommendation for managing comorbidities with obesity, such as elevated blood lipids and glucose, despite ample evidence that weight loss attempts generally lead to weight regain and weight cycling, which are associated with negative mental health outcomes like anxiety and depression. Experts have called for non-weight loss obesity management, by emphasizing health behaviors such as physical activity. An effective method to deliver physical activity interventions is via mobile apps, of which women are the most frequent users. However, most physical activity apps emphasize weight loss.

The goal of the new Phase I SBIR project is to demonstrate the technical merit and feasibility of developing a smartphone mobile app (NoWeigh!) to support physical activity engagement using the tenants of body neutrality and Self-Determination Theory as frameworks. Mobile health (mHealth) approaches using smartphones offer several advantages for dissemination and implementation of health interventions including that they are portable, typically “on,” readily available, affordable, and offer advanced functionality. In addition, ownership of smartphones among adults is high, enabling potentially vast reach and apps have been shown to improve uptake of, and adherence to, healthy lifestyle strategies.

Project Specific Aims

Aim 1: Perform iterative focus groups in adult women (aged ≥18 years) from diverse backgrounds to collect potential-user information to identify barriers, needs and preferences for a body-neutrality physical activity app design.

Aim 2: Design the conceptual model and develop planned components of the NoWeigh! app which will include storyboards and clickable wireframes.

Aim 3: Conduct beta and usability testing on the clickable wireframes prototype of the NoWeigh! app to show feasibility, acceptability and potential for engagement, and finalize the app design.

Successful completion of Phase I SBIR research will provide evidence to support a larger Phase II project to program and test the full-scale NoWeigh! app in a randomized comparative effectiveness trial. The goal is to produce a commercially ready mobile app for physical activity promotion that does not center on weight loss, a cost-effective lifestyle intervention for decreasing disease risk and reducing healthcare costs. This mHealth approach is an ideal medium for physical activity promotion because the reach, portability, and advanced functionality of mHealth devices allows for effective use by a broad range of adult women.

This grant was awarded to Klein Buendel by the National Institute of Diabetes, Digestive and Kidney Diseases (DK142209; Dr. Kayla Nuss, Principal Investigator). Dr. Nuss’ research collaborator on this project is Anne Poirier. She is the owner of a body neutrality coaching company and the author of the book, The Body Joyful, a guide to a life based on self-care and compassion. The NoWeigh! app will be designed and programmed by the Creative Team at Klein Buendel.

MobileMen Project Protocol

MobileMen Project Protocol

African American men are at higher risk for serious health conditions such as cardiovascular disease, diabetes, and stroke compared to non-Hispanic White men. Physical activity is a modifiable health behavior that has been shown to decrease chronic disease risk. Still, engagement in physical activity is alarmingly low in African American men. While interventions to improve physical activity engagement are effective in several populations, very few have been tailored to the unique needs of African American men. Even fewer have leveraged mobile health apps, despite African American men’s interest in and willingness to use such technologies for health improvement.

Now a multi-disciplinary research team from Klein Buendel, Pennington Biomedical Research Center, and three universities is conducting a comparative effectiveness trial that aims to evaluate MobileMen, a physical activity promotion app tailored to the needs and preferences of African American men. The team has published the plans and methods for the trial in JMIR Research Protocols.

The trial compares the MobileMen app to a commercially available physical activity promotion app with similar features but without culturally tailored components. Specifically, the study is recruiting a sample of 100 “low active” (less than 7500 steps per day) African American men aged 30 years or older from Baton Rouge, Louisiana and its surrounding communities. All participants are given a Fitbit Charge 6 wearable activity tracker to assess daily physical and steps. Participants are randomly assigned to either the MobileMen intervention app or a comparator app. The intervention period is six months, during which participants will interact with their assigned mobile app.

MobileMen includes features such as digital badges earned for physical activity, tangible prizes like exercise equipment, challenges among participants, goal setting, nutrition, physical activity, and behavior change educational information in text, audio, and video formats.

Participants complete assessments at baseline and at six months after random assignment. Assessments include objective measurements of daily steps and minutes of moderate to vigorous physical activity, quality of life, dietary measures, self-efficacy for fruit and vegetable consumption and physical activity, and autonomous motivation for physical activity. Detailed descriptions of measures and methods can be found in the JMIR Research Protocols paper.

Mobile apps are a widely accessible means to disseminate culturally tailored physical activity promotion interventions to various populations, including African American men. MobileMen has the potential to impact physical engagement in African American men, to help improve the overall health and chronic disease risk in this underrepresented population.

This research is funded by an STTR Fast Track grant to Klein Buendel from the National Institute on Minority Health and Health Disparities (MD014947). The Principal Investigator is Dr. Robert Newton from the Pennington Biomedical Research Center. Authors on this paper include Callie Hebert, Phillip Nauta, and Dr. Robert Newton from the Pennington Biomedical Research Center; Dr. April Stull from Baylor University; Dr. Damon Swift from the University of Virginia; Dr. Derek Griffith from the University of Pennsylvania; and Dr. Kayla Nuss, Amanda Brice, and Dr. David Buller from Klein Buendel. The MobileMen app was programmed by the Klein Buendel Creative Team.

Content Analysis of Posts Featuring Popular Instagram Fitness and Exercise Trends

Content Analysis of Posts Featuring Popular Instagram Fitness and Exercise Trends

Four main health and wellness trends have emerged on social media over the past several years: thinspiration, fitspiration, body positivity, and body neutrality. Thinspiration is intended to inspire consumers to obtain a very thin body and is often considered to be promoting disordered eating behavior. Fitspiration intends to inspire consumers to participate in exercise and aspire to a “fit” body. Body positivity promotes acceptance and appreciation of all body types and body neutrality prioritizes the function of the body, rather than its appearance. The content of body neutrality posts has gone largely unexamined, and no study has comparatively examined the content of fitspiration, body positivity, and body neutrality – until now.

Dr. Kayla Nuss, Klein Buendel Scientist, and her co-authors have published new data on the content of Instagram posts pertaining to exercise in the journal, Psychology of Popular Media. The paper is entitled, “What’s in a Hashtag? A Comparative Content Analysis of Fitspiration, Body Positivity, and Body Neutrality Posts on Instagram.”

The research team conducted a comparative analysis of 200 Instagram posts from three categories: fitspiration, body positivity, and body neutrality. There were 605 total posts. All content types featured mostly White women, although fitspiration featured slightly more racial diversity. Most people featured in fitspiration and body positivity posts were thin whereas the majority of those in body neutrality posts were of average body size. Commercialization was the most prominent message in all three content types and weight loss was featured often in both fitspiration and body positivity posts.

Based on these results, the authors conclude that body positivity has seemingly drifted away from its original intention and body neutrality now seems aligned with the origins of body positivity. Full descriptions of the study design, methods, results, and limitations are provided in the Psychology of Popular Media publication. In the paper, the authors offer recommendations for researchers to develop social media health behavior interventions using elements of these popular content types.

This research was sponsored by Klein Buendel and led by Dr. Kayla Nuss. Her collaborators included Julia Berteletti, Dr. Barbara Walkosz, Irene Adjei, Annelise Small, Liliana Salcido Beltran, and Noah Chirico from Klein Buendel; Anne Poirier from Shaping Perspectives in South Carolina; and Dr. Danielle Arigo from Rowan University in New Jersey.

6th International Conference on UV and Skin Cancer Prevention: Posters

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).