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Results of the Pinpoint Project

Results of the Pinpoint Project

The Pinpoint web app was created and evaluated by Klein Buendel in collaboration with HPC International through a grant funded by the National Institute on Minority Health and Health Disparities (MD010746; Dr. Valerie Myers, Principal Investigator). Designed for adolescents aged 13-17, the Pinpoint web app provides education on communication strategies and sickle cell disease (SCD) care management. Pinpoint includes a pain assessment tool, vocabulary game, body scanner reflection, and educational self-disclosure activity. It was developed as an interactive gaming web app for use on smartphones, tablets, and desktop computers. Learning Buddies were added to act as a guide for the teen in the app to explain each activity and feature with text and voiceover. There are two Learning Buddy characters to choose from, each of whom had their own fictional story about living with SCD. Learning Buddies are customizable, allowing teen participants to choose clothing, hair style, and skin tone upon registering for the app. For each activity the teens participate in, points can be earned to unlock additional customization options, including hats, jewelry, and more hairstyles and clothing options. A Self-Disclosure Stories section was also added to the web app. This consists of stories from real people, including children, young adults, and older adults living with SCD.

The fully developed app was used to interview clinicians to evaluate content and clinical meaningfulness (n=10). Additionally, adolescents (n=11), aged 13-17, with SCD participated in usability testing to evaluate the user interface, ease of use, and perceived barriers. Both clinicians and teens participating in the usability study were encouraged to go through the app on their own while sharing their screen and describing aloud their thoughts and impressions of the app. They were then guided to specific parts of the app (such as the vocabulary game, self-disclosure activity, Pain Assessment Tool, Body Scanner Reflection, and Learning Buddies) to review.

Overall, clinicians believed the app content was meaningful and engaging, would help their patients better identify SCD pain and would help them better treat their patients’ pain. Clinicians also said they would encourage SCD patients to use the app. Teen participants in the usability testing found the app to be easy to use and understand. They enjoyed the interactivity of the games, found the Learning Buddy to be interesting and relatable, and liked that they could share the information recorded on the pain assessment tool with caregivers and healthcare providers by text or email.

In a subsequent randomized, stepped-wedge trial, the app was tested with 13–17-year-olds with SCD and one of their parents to evaluate changes in knowledge acquisition for communicating about pain. Community-based recruitment strategies were used. This involved attending SCD conferences, creating relationships with community-based organizations (such as sickle cell associations, sickle cell camps, libraries, Boys and Girls clubs, YMCAs, and clinics), online recruitment (such as Facebook/Reddit ads and posting in SCD-specific groups on Facebook/Reddit), partnering with companies that specialize in recruiting for SCD research, and snowball recruitment. Through these efforts, 24 teen/parent dyads were successfully recruited and randomly assigned to study group.

Both teens and their parent took a survey every 4 weeks for 12-16 weeks and used the app for 4-12 weeks, depending on which arm of the study they were assigned. Parents and teens randomized into Arms 1-3 took surveys every 4 weeks for 12 weeks and downloaded the Pinpoint app at Baseline (Arm 1; used the app for 12 weeks), 4 Weeks (Arm 2; used the app for 8 weeks), or 8 Weeks (Arm 3; used the app for 4 weeks), while participants in Arm 4 took surveys every 4 weeks for 16 weeks and downloaded the Pinpoint app at 12 Weeks (used the app for 4 weeks). Surveys were completed during a virtual check-in via Zoom with a member of the study staff. There was 100% retention of both parents and adolescents throughout the intervention for follow-up surveys.

Adolescents reported on pain interference, peer relationships, physical stress experiences, psychological stress experiences, pain behavior, pain quality, experiences with providers, family relationships, communication, and personal experiences with the SCD. Parents were assessed on disease knowledge, family relationships, family communication, and their experiences managing their child’s SCD. The adolescents were 92% African American, 8% Hispanic, 54% male, and the mean age was 14.8. SCD was not a new disease for any of the participants. The parents were 93% African American, 4% Hispanic, 92% female, and the mean age was 44.9. The small sample size prohibits the investigators from evaluating changes between groups, though summary statistics at each time point were created and reviewed.

In the final surveys, adolescents also reported on the usability of the web app:

At the baseline and the final survey time points, adolescents reported on communication and SCD pain management:

Lastly, web app usage data was collected. From the 24 adolescents randomized, 34 pain reports were entered by 16 unique users (67%) within the app. Of those pain reports recorded, 20 (59%) were shared with their parent or health care provider via the app.

Pinpoint is available to individuals and medical providers. To learn more about the Pinpoint app, check out the video tutorial or visit HPC International.

KB Investigators Present at EUSPR

KB Investigators Present at EUSPR

Three Klein Buendel Principal Investigators gave presentations on their recent or active research projects at the 14th European Society for Prevention Research Conference held October 4-6, 2023 in Sarajevo, Bosnia and Herzegovina. The presenters were Dr. David Buller, Director of Research, Dr. Barbara Walkosz, Senior Scientist, and Ms. Mary Buller, President. Each presentation complemented the conference theme of “Optimizing Prevention Infrastructures.” The prevention interventions were implemented in workplaces to reach their target populations directly and impactfully.   

Presentation 1

Dr. David Buller

“Formative Research on Professional Development Training to Maintain Responsible Beverage Service Practices”

Improved interventions are needed to reduce the negative consequences of alcohol intoxication. Responsible beverage service (RBS) training has been effective at reducing service to intoxicated customers in some cases. Its efficacy might be improved with an intervention that supports RBS techniques in the years between government-required RBS retraining. We conducted formative research to develop an ongoing professional development component for an online RBS training.

Formative research explored feasibility, acceptability, and content for an ongoing professional development intervention for alcohol servers. Semi-structured interviews were performed with owners/managers of licensed establishments (n=10) and focus groups (n=19) and survey (n=24) with alcohol servers in New Mexico and Washington. A prototype of a professional development component was produced, covering advanced RBS skills, support from experienced servers, professionalism, and basic management training, for delivery through social media. It was evaluated in a usability survey with alcohol servers (n=20) in California, New Mexico, and Washington.

While owners, managers, and alcohol servers were favorable toward RBS in their establishments, they endorsed the need for ongoing support for RBS for servers. Among topics of high interest were sharing tips, methods, and stories from experienced servers, balancing pressure to sell, navigating adult-use marijuana laws, dealing with children, recognizing intoxication, and managing difficult customers. The prototype was comprised of 50 social media posts, including text, infographics, videos, and interactive activity. Servers rated it as highly usable and appropriate for themselves and the establishment. Most servers (70%) were interested in receiving the ongoing information and activities.

Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed establishments. Servers were interested in using such program. The professional development component has the potential to improve an existing RBS intervention.

Collaborators on this presentation included Dr. David Buller and Dr. W. Gill Woodall from Klein Buendel, and Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation in California. This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA029364; W. G. Woodall and D. Buller, MPIs).

Presentation 2

Dr. Barbara Walkosz

“Sun Safety Ink!: Sun Safety Practices of Tattoo Studio Clients”

Melanoma is the second most common cancer among young adults in the United States. Sunburn prevalence and low rates of sun protection are elevated in this group. Thus, efforts are needed to promote skin cancer prevention. An estimated 225 million people worldwide have tattoos with 40% of adults ages 18-29 with at least one tattoo, and at least 30% of American have tattooed skin. Sun Safety Ink! is a skin cancer prevention program targeted to clients of tattoo studios The goal of Sun Safety Ink! is to promote full-body comprehensive sun protection to clients of tattoo studios to compliment standard aftercare instructions that recommend sun protection for new tattoos.

Thirty-seven tattoo studios were enrolled in the Sun Safety Ink! program. At pretest, clients were recruited by tattoo artists to complete an online survey that assessed current self-reported sun protection (sunscreen, lip balm, hats, protective clothing, sunglasses, and shade), number of sunburns, and sunbed tanning frequency in the last year. Respondents were also asked to locate the position of tattoos on their body, using a drawing tool. 

A total of 861 clients completed the online survey. Respondent demographics: age, average 31 yrs.; 67% female, 30% male; 60% white, 27% more than one race, 2% African American, 1% Asian and Native American, 13% Hispanic/Latino. The most prominent tattoo locations included: front left arm, 66%, front right arm, 58%, front upper torso, 52%, and back upper torso, 48%. Sun safety practices, that is, full body sun protection, (on a 5-point scale of “always” to “never”) were reported as: apply sunscreen SPF 15+ on face (aftershave, face lotion, or make-up), 3.31; apply sunscreen SPF 30+ on all exposed skin areas, 3.22; reapply sunscreen, 3.08; apply a lip balm, 3.28; wear any hat, 2.91; wear wide-brimmed hat, 2.21; wear sunglasses, 3.89; stay mostly in the shade, 3.38; and wear protective clothing, 2.91. Respondents also reported the number of sunburns as 1.53 and number of times indoor tanning as 1.11 in the last 12 months.

The pretest results indicate that full-body sun safety practices of tattooed adult can benefit from improvement, particularly wearing of hats and sun protective clothing. Further, knowledge of tattoo locations can direct sun safety recommendations to include protecting not only tattoos on arms and torsos but also non-tattooed skin on those areas of the body. Tattoo studies may be a viable location to delivering effective sun safety interventions to hard-to-reach tattooed, young adults.

Collaborators on this presentation included Dr. Barbara Walkosz, Ms. Mary Buller, and Dr. David Buller from Klein Buendel, and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the Department of Veteran Affairs. This research was supported by a grant (CA206569; B. Walkosz, PI) from the National Cancer Institute.

Presentation 3

Ms. Mary Buller

“Protection from Solar Radiation in the Era of Climate Change: Preventing Heat Illness and Skin Cancer for Outdoor Workers”

The sun’s energy is both a necessity and a threat to humans. Extreme heat linked to climate change and unprotected exposure to ultraviolet radiation (UV) make people who work outdoors vulnerable to life-threatening heat illness and skin cancer. It is estimated that infrared radiation (heat) and UV contributed to over 120,000 deaths from skin cancer in 2020 and over 350,000 deaths from excessive heat in 2019. Efforts to protect workers from heat or UV can work in tandem to help outdoor workers adapt to the warming world.

Workplace interviews, a review of literature, and expert consultants helped expand an existing intervention for U.S. occupational skin cancer prevention to include heat illness prevention, and to be delivered online. Content consultants include safety training professionals, behavioral scientists, and dermatologists. The program, Go Sun Smart at Work (GSSW), will be evaluated in 2024 in a randomized controlled trial enrolling 20 U.S. employers.

GSSW is an innovative virtual learning environment and resource hub promoting comprehensive solar radiation policy, training, and personal protection for outdoor workers. It includes (1) a manager resource hub that guides decision-makers through implementation strategies using a structured conversation agent; (2) an employee sun safety training video that is compliant with eLearning standards and compatible with learning management systems for monitoring; and (3) a trove of resources and downloadable materials addressing heat illness and skin cancer prevention. The structured conversational agent adjusts workplace implementation strategies for management’s readiness to innovate on sun safety based on Diffusion of Innovations Theory.

GSSW will help outdoor workers protect themselves from the serious threats of climate change by providing employers with a convenient, comprehensive solar radiation safety policy and training program. It will support the shift to online training to improve accessibility, fidelity, adherence, and tracking, while saving resources.

Collaborators on this presentation included Ms. Mary Buller, Dr. Barbara Walkosz, Ms. Julia Berteletti, Mr. Brandon Herbeck, Ms. Irene Adjei, and Dr. David Buller from Klein Buendel. This research was supported by a grant (CA257778; M. Buller, PI) from the National Cancer Institute.

Custody & Caring Conference

Custody & Caring Conference

A research team from Penn State University and Klein Buendel gave three presentations on their recent work related to the care of persons aging and dying in prison at the 18th Biennial International Conference on the Nurse’s Role in the Criminal Justice System. The Custody & Caring Conference was held in Saskatoon, SK, Canada on September 20-23, 2023.

Podium Presentation and Poster 1

“Small-Scale Usability Testing: E-learning Modules for Peer Caregivers”

Growing numbers of people globally will grow old and die while incarcerated. Research evidence supports using peer caregivers to assist staff with geriatric and end-of-life care. Currently, peer caregiver training varies widely in content and duration. Evidenced-based, accessible, and contextually relevant materials are needed to effectively prepare the caregivers. This study’s purpose was to conduct research and development of Just Care, a six-module e-learning program for peer caregivers and a single module to guide corrections staff in implementing the program. University IRB, U.S. Department of Health & Human Services, and Department of Corrections permissions were obtained, and participants signed informed consent. Deputy Wardens assisted in identifying people meeting our inclusion criteria. Nineteen people living in prison and 11 staff took part in the usability testing of the progam. Researchers directed participants to share their thoughts aloud. Field notes were taken. Participants completed six open-ended questions and the System Usability Scale (SUS).

Findings focused on functionality, design, and content of Just Care. All users easily navigated through the program with minimal guidance. Many noted Just Care’s utility for future peer caregivers. Challenges faced were clustered by level of severity from 1-3 (1=most; 3=least severe). There were no severity-level 1 issues in either round. In Round 1, Just Care received a SUS score of 87.5 by incarcerated users and 74.5 by staff. A SUS score of 68 is an above average score. Following rapid refinement, Round 2 incarcerated participants scored Just Care at 85.28 while staff scored it at 83.75. Some incarcerated users had difficulty navigating the post-test assessments in Round 2. A few staff users noted liking the additional resources available via links to PDFs. One staff user voiced concern about the safety of having incarcerated people help with care. Overall, participants found Just Care easy to navigate with interactive content that is very useful, engaging, and relevant to providing geriatric and end-of-life care in prisons. Staff also noted that Just Care raised awareness about the growing need for programming on geriatric care in prisons and that a peer caregiver program like Just Care is a viable solution that is implementable by prison staff.  

Poster 2

“Determining Priority Dementia Care Training Needs for Correctional Staff and Peer Caregivers”

People aged 50 and older in prisons are at particular risk for developing Alzheimer’s Disease and Related Dementias (ADRD) due to several social determinants of health. The number of patients in prison with ADRD is not known. This situation can likely be attributed to many corrections health, social, and security staff lacking the requisite skills for identifying ADRD. Dementia care inequities between prisons and community settings need to be addressed. A standardized, feasible, and acceptable ADRD education program developed for those caring for and/or managing people who are incarcerated and living with ADRD is a pressing need.

The key purpose of the research was to identify three priority learning needs of multidisciplinary prison staff to provide enhanced management and care for people living with ADRD in prisons which also represented the critical learning needs of peer caregivers so that they may assist staff with ADRD care. The study also sought to identify a logo to brand the new Just Care for Dementia training. The third outcome was to translate best practices from community-based ADRD care into accessible and relevant content for training staff and peer caregivers that is evidence-based and can be programmed into highly interactive prototype e-learning modules that fit within the restrictive context of corrections. Focus group methodology facilitated potential future users input to aid us in ensuring the content, design, and technology plans match the needs and constraints of prison. Approvals were secured from the: Institutional Review Board; federal government; and Department of Corrections. Participants provided signed informed consent. The settings were one men’s and one women’s state prison in the United States. Twelve interdisciplinary staff and 11 peer caregivers participated.

Thematic analyses revealed three priority content areas: fostering a safe and calm environment; addressing behavioral and psychological symptoms of dementia; and enhancing awareness of need. Insights on nine showcased logos revealed two clear preferences. Consultation with the study’s advisory board informed final logo selection for branding the Just Care for Dementia e-learning product. In conclusion, participants confirmed the need for a such a training program and indicated this is a viable approach to addressing a pressing training and related care need in prisons.

This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging [AG057239; Dr. Susan Loeb (Penn State) and Dr. Barbara Walkosz (Klein Buendel), Multiple Principal Investigators]. Collaborators on the presentation and posters also included Dr. Erin Kitt-Lewis, Mr. Sherif Olanrewaju, and Ms. Katherine Aiken from The Penn State University; and Mr. Brandon Herbeck, Ms. Amanda Brice, and Mr. Steve Fullmer from Klein Buendel.  

Challenging Violence in the Media

Challenging Violence in the Media

Klein Buendel and the Center for Media Literacy in California are launching a new research project to update and translate Beyond Blame: Challenging Violence in the Media, an evidence-based media-literacy violence prevention curriculum for middle school students, formerly delivered in person, into an interactive technology-based platform. Beyond Blame, developed by the Center for Media Literacy,is a theory-based curriculum that underwent a rigorous long-term evaluation, in the Los Angeles Unified School District. Violence prevention programs, including school-based education programs, are recommended to address youth violence.

According to the Centers for Disease Control and Prevention (CDC), “youth violence is a serious public health problem and that an adverse childhood experience can have a long-term impact on health and well-being, disproportionately impacting communities of color.” Violence affects thousands of youths each day as well as their families, schools, and communities. CDC reports that youth can be involved in violence as a victim, offender, or witness. Homicide is the third leading cause of death for young people ages 10-24 and the leading cause of death for non-Hispanic Black or African American youth.1,2 However, youth violence is preventable and the development of evidence-based approaches that address the factors to decrease the risk of violence, buffer against that risk, and promote positive youth development and well-being3 are imperative.  

A number of factors exist that may increase or decrease the possibility of youth experiencing or enacting violence. Media violence has long been identified by public health as a risk factor and violent content in television, social media, and video games has been associated with aggression and youth violence. Yet, media literacy programs are often not included in violence prevention efforts. Media literacy is recognized as a life skill to strengthen and provide resiliency for an individual’s ability to resist negative and harmful messages that are powerfully packaged and promoted in the media.

Today, youth live in an unprecedented mediated environment. With technology allowing 24-hour media access, the amount of time youth spend with media has risen dramatically, especially among minority youth. This is evidenced by widespread media usage by middle school children: 98% watch television, 78% use tablets, 67% interact with smart phones, 73% use computers, and 68% use gaming devices. Children ages 8-12 in the U.S. average 4-6 hours a day watching or using screens. To help children navigate this mediated environment, media literacy education provides a framework to access, analyze, evaluate, create and participate using media in a variety of forms, including videos, social media (such as TikTok and You Tube), video games, film, and television.  

Upon completing Beyond Blame in person, students significantly increased their knowledge of the Five Core Concepts/Key Questions of media literacy, increased recognition of their exposure to media violence, and had stronger beliefs that media violence affects users. The original Beyond Blame aligns with the Common Core standards identified for Language Arts, and the technology-based curriculum will adhere to the same standards along with the International Society for Technology in Education Standards that ensure that using technology for learning can create high-impact, sustainable, scalable, and equitable learning experiences for all learners. 

This research is supported by a grant from the CDC (CE003635). The project team will be led by Multiple Principal Investigators, Dr. Barbara Walkosz, a Senior Scientist at Klein Buendel, and Ms. Tessa Jolls, President of the Center for Media Literacy and will be joined by a Co-Investigator, Dr. Christine Rizzo from Northeastern University in Massachusetts. The Klein Buendel Creative Team will design and program the Beyond Blame prototype. 


  1. David-Ferdon C, Clayton HB, Dahlberg LL, et al. Vital signs: Prevalence of multiple forms of violence and increased health risk behaviors and conditions among youths – United States, 2019. MMWR Morb Mortal Wkly Rep. 2021;70(5):167-173. doi: 10.15585/mmwr.mm7005a4.PMC7861486  
  2. Sheats KJ, Irving SM, Mercy JA, et al. Violence-related disparities experienced by black youth and young adults: opportunities for prevention. Am J Prev Med. 2018;55(4):462-469. doi: 10.1016/j.amepre.2018.05.017.PMC6691967 
  3. Youth topics: violence prevention. Interagency Working Group on Youth Programs. Available at: Accessed March 28, 2022. 
Introducing Way To Serve Español!

Introducing Way To Serve Español!

WayToServe®, an evidence-based online responsible alcohol server training program, has been launched in Spanish in California – as Way To Serve Español – to meet the needs of Spanish-speakers in the food and beverage industry.

Responsible Beverage Service (RBS) training has shown promise to reduce alcohol-related injury and mortality. 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 randomized controlled 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 expanded and approved for sale and certification of trainers in New Mexico, California, Texas, and Washington. Wedge Communications will distribute Way To Serve Español, as well.

The original WayToServe project was sponsored 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 subsequent WayToServe Español project was sponsored by a grant from the National Institute of Minority Health and Health Disparities (MD010405; Dr. W. Gill Woodall, Klein Buendel Senior Scientist, Principal Investigator). Collaborators 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; Dr. David Buller, Ms. Jeanny Camacho Reither, Ms. Lila Martinez, and Ms. Marita Brooks from Klein Buendel. 

Results of the ¡Caminemos Juntas! Project

Results of the ¡Caminemos Juntas! Project

Klein Buendel researchers and collaborators from Stanford University have completed an SBIR Phase I and II project to develop and evaluate the effectiveness of the first smartphone app to use geo-location technology dedicated to walking with a social emphasis for exercise and quality of life for Latinas.

Health disparities are high among Latinas. They are more likely to be overweight, diagnosed with diabetes, and physically inactive compared to their non-Hispanic White counterparts. Despite numerous interventions designed to increase physical activity, few are specifically tailored to Latinas. Thus, this project developed ¡Caminemos Juntas!, a smartphone app that uses location-based services to connect Latinas with one another in order to improve walking habits by increasing social support and decreasing perceived barriers.

Available data suggest that community-focused interventions produce improvements in physical activity and are well-received by Latinas, especially when social and physical environments, such as social support and safe walking areas, are considered. Research suggests that Latinas respond favorably to technological-based health interventions. Thus, health promotion interventions that can address Latinas’ preferences regarding their physical and social environments while utilizing a preferred technology source have the potential to be very effective.

Phase I Project

In the Phase I project, formative research was conducted to guide development of a prototype smartphone app for the target population. Specifically, the research and development team:

(1) gathered feedback from an Expert Advisory Board to help plan and assess the feasibility of creating the app;

(2) built connections and gathered input from Latina community leaders to assist in the conceptual development of the app through a Community Advisory Board;

(3) conducted an online survey of a national sample of Latinas on their smartphone usage for health promotion, and interest in social networking and location-based technology features;

(4) conducted iterative focus groups with Latinas to guide development of app content, design, and aesthetics to fully develop a functioning prototype;

(5) conducted field usability testing with Latinas to test the app’s accuracy to establish users’ location and connect users through the ¡Caminemos Juntas! system and users’ use and satisfaction with the app; and

(6) developed a specifications document to outline the Phase II development and programming plan.

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

Phase II Project

In the Phase II project, the ¡Caminemos Juntas! app was fully developed and evaluated in a randomized comparative-effectiveness trial with Latinas in San Jose, CA and Denver, CO. The location-based features of the app allowed Latinas to determine a safe place to meet for a walk, connect with other users nearby, and be notified if there was an available walk in the user’s vicinity. Specifically, the research and development team:

(1) developed a full-scale, fully programmed ¡Caminemos Juntas! app;

(2) determined whether the ¡Caminemos Juntas! app can be translated and adapted to a new community environment;

(3) tested the performance, usage, and usability of the full-scale, fully-programmed app; and

(4) evaluated whether ¡Caminemos Juntas! increases physical activity, social support for exercise, and quality of life in Latinas as compared to a control app.

The ¡Caminemos Juntas! app (intervention group; n=38) was compared to use of the World Walking App (control group; n=40). Women ages 18 to 67 who identified as Hispanic or Latina were eligible to participate. Recruitment, retention, and implementation were hindered significantly by the onset of the COVID-19 pandemic. The intervention was set to launch in the spring of 2020. Recruitment was delayed and when it was determined that the pandemic would be a long-term hinderance, changes were made to the app to allow participants to complete virtual walks instead of in-person. Eighty-eight percent (88%) of participants (n=69) completed measures at 4 weeks and ninety-seven percent (97%) of participants (n=76) completed measures at 8 weeks.

The primary outcome measure was change in physical activity at 4 and 8 weeks using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. The CHAMPS is a 41-item questionnaire that measures self-reported minutes-per-week of physical activity calculated as total weekly caloric expenditure for all physical activity. It was developed for underactive populations and validated among older adults. The CHAMPS asks about activities undertaken for exercise, daily activities that are physical in nature, and physically active recreational activities during a typical week in the past 4 or 8 weeks. Each question has six answer options that range from “Less than 1 hour” to “9 or more hours.” At the 8-week follow-up, participants in ¡Caminemos Juntas!  reported 5.2 hours per week of moderate-intensity exercise related activities per week compared to 4.3 hours in the control group, though this result is not statistically significant.

Participants in the intervention group reported living in more walkable (35.3% of intervention participants rated their sidewalks very well maintained compared to 17.7% of control participants (p=0.04) and safer neighborhoods (63.6% of participants in the intervention rated the public recreation facilities in their neighborhood as very safe compared to 31.6% in the control (p=0.03). However, ¡Caminemos Juntas! users reported significantly lower street connectivity than the control group.

Overall, the ¡Caminemos Juntas! app was found to have the potential to impact Latinas’ health by providing them with real-time opportunities to connect socially with the goal of walking. Interventions that target improving health access and ameliorating chronic diseases among Latinas are of high public health importance.

This research was supported by a grant from the National Institute on Minority Health and Health Disparities (MD009652; Dr. Valerie Myers, former Klein Buendel Senior Scientist) at the National Institutes of Health. Dr. Myers’ primary collaborator was Dr. Abby King from Stanford University.

Collaborator Spotlight:
Dr. Douglas Seals and Dr. Daniel Craighead

Collaborator Spotlight:
Dr. Douglas Seals and Dr. Daniel Craighead

Two accomplished integrative physiology scientists from the University of Colorado Boulder are launching a new research project in collaboration with Dr. Kayla Nuss and the Creative Team from Klein Buendel. The project will design and assess the feasibility of the using a smartphone app to help deliver a high-resistance inspiratory muscle strength training (IMST) program for improving blood pressure and reducing cardiovascular disease risk in midlife and older adults.

Douglas Seals, PhD, is a Distinguished Professor of Integrative Physiology (Boulder Campus) and Medicine (Anschutz Medical Campus) at the University of Colorado. He is also the Director of the Integrative Physiology of Aging Laboratory. He earned his doctoral degree in Applied Exercise Physiology from the University of Wisconsin in 1981. In his 35+ years of academics and research, Dr. Seals has become an expert on lifestyle and/or pharmacological interventions to improve cardiovascular function. His areas of research interest include cardiovascular aging, such as changes in systolic blood pressure, large artery stiffness, and vascular endothelial function; biological and lifestyle factors that influence cardiovascular aging; the integrative (molecular to systemic) mechanisms that mediate cardiovascular aging and its modulation by biological and lifestyle factors; and interventions to improve adverse physiological changes with aging, including cardiovascular dysfunction, reductions in motor performance, and impairments in cognitive function. His research has been continuously funded by research grants from the National Institutes of Health, particularly the National Institute on Aging, since 1986. Dr. Seals founded an NIH Clinical Translational Research Center at the University of Colorado Boulder in 1999 as a core facility for conducting biomedical research on human subjects. It was in this lab that Dr. Seals and Dr. Daniel Craighead (see below) established the efficacy of IMST for lowering blood pressure in a traditional clinical research setting. In 2004, Dr. Seals received a 10-year MERIT Award from the National Institute on Aging to support his research on cardiovascular aging. In 2008, he was named a Professor of Distinction in the College of Arts and Sciences at the University of Colorado Boulder. In 2013, he was named an Edward F. Adolph Distinguished Lecturer by the American Physiological Society for his work in the physiology of aging.

Daniel Craighead, PhD, is an Assistant Research Professor in the Department of Integrative Physiology at the University of Colorado Boulder. He earned his doctoral degree in Kinesiology from Penn State University in 2017, and completed a post-doctoral fellowship in the Integrative Physiology of Aging Laboratory at the University of Colorado Boulder in 2020. Dr. Craighead is a specialist in the study of IMST for lowering blood pressure. Dr. Craighead conducted the initial R21-supported clinical trial on IMST, upon which the new research project with Klein Buendel is based. The Small Business Technology Transfer (STTR) Phase I study is supported by the National Heart, Lung, and Blood Institute, and will design and assess the feasibility of a smartphone app for delivering an IMST program and improving blood pressure in midlife and older adults. The program will provide instruction and promote adherence to the IMST intervention. Ultimately, the app will provide for widespread dissemination and adoption of an innovative tool to easily lower blood pressure and reduce cardiovascular disease risk. Dr. Craighead also has been the Principal Investigator on a study assessing the efficacy of nicotinamide riboside, a dietary supplement, for lowering blood pressure and improving vascular function in older adults, among other research projects.

IMST for Reducing High Blood Pressure

IMST for Reducing High Blood Pressure

Midlife and older adults exhibit a rapid increase in systolic blood pressure (SBP) which is associated with an increased risk for cardiovascular diseases. Researchers at the University of Colorado Boulder recently established the clinical efficacy of high-resistance inspiratory muscle strength training (IMST), a novel form of physical training with minimal barriers to adherence, for lowering SBP in midlife and older adults in a clinical trial with regular clinic-based, researcher-supervised training.

A new Phase I STTR project seeks to leverage the growing field of digital health technologies by taking the first steps in developing a feasible and acceptable smartphone app that independently guides users through a high-resistance IMST program, a key step to translate IMST for widespread use and improving public health.

The research grant has been awarded to Klein Buendel and will be led by experts in cardiovascular health, aging and high-resistance IMST from the University of Colorado Boulder (Dr. Douglas Seals, Principal Investigator; Dr. Daniel Craighead, Co-Investigator) and digital health technology development and delivery from Klein Buendel (Dr. Kayla Nuss, Co-Investigator). The one-year project will collect feedback and preferences from potential users to guide app development and demonstrate feasibility of such a mobile app.

Specific Aims

Aim 1: Perform iterative focus groups in midlife/older adults with above-normal SBP to collect potential-user information to identify needs and preferences for effective IMST app design.

Aim 2: Design the conceptual model and develop planned app components, including printed wireframes, storyboards, and clickable wireframes.

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

Successful completion of this Phase I study will provide evidence to support programming and evaluating the full-scale IMST app in a subsequent Phase II project. If awarded, the Phase II project would directly compare the efficacy of at-home, self-guided IMST with the app vs. home BP monitoring alone (usual care control) for lowering SBP in a randomized clinical trial. The ultimate research goal of Phases I and II is to produce a commercially-ready mobile app for at-home implementation of high-resistance IMST, as a cost-effective lifestyle intervention for lowering SBP, decreasing disease risk, and reducing health care costs.

The research is supported by a grant from the National Heart, Lung, and Blood Institute at the National Institutes of Health (HL167375; Dr. Douglas Seals, Principal Investigator).  

Physical Activity Research with Apps and Wearable Trackers

Physical Activity Research with Apps and Wearable Trackers

Klein Buendel Scientist, Dr. Kayla Nuss, was a presenter or co-author on four panels, posters, and presentations at the 44th Annual Sessions and Meeting of the Society of Behavioral Medicine in Phoenix, Arizona on April 26-29, 2023. The presentations highlighted research Dr. Nuss conducted as a Post-doctoral Fellow at the University of Victoria in Canada before joining Klein Buendel as a Scientist in 2022.

Dr. Kayla Nuss at SBM

Presentation 1: Poster Session

“Examining the Effect of Daily Social Media Use of Physical Activity Behaviors: A Daily Diary Study”

Presenters: Ms. Rebecca Coulter, Dr. Sam Liu, and Dr. Kayla Nuss

Previous studies have assessed the effects of health-related social media use on physical activity; however the evidence remains mixed. Currently, little is known about how daily social media use influences daily physical activity behavior. Understanding the influence of social media use on physical activity behavior may help design future interventions. The objective of this study was to examine whether the daily consumption of health-related social media content is associated with daily physical activity behaviors. Results provided evidence that viewing health-related social media content can influence daily physical activity behavior – specifically , exercise intensity. The authors suggested that future studies should focus on within-person variations in behavior based on social media use.

Presentation 2: Symposium 1

“Contextual and Situational Motivation for Physical Activity in Wearable Activity Tracker Users: A Daily Diary Study”

Presenters: Ms. Rebecca Coulter, Dr. Sam Liu, and Dr. Kayla Nuss

Wearable activity trackers (WAT) were developed to support physical activity engagement but little is known about how WAT users are motivated for physical activity. The presenters have identified distinct motivational profiles among WAT users; but no study has assessed the relationship between contextual and situational motivation for physical activity. To evaluate this relationship, intensive daily survey methodology is needed. Understanding the relationship between contextual and situational motivation for physical activity is critical to improve the effectiveness of WAT. The objectives of the study were to: (1) evaluate the feasibility of collecting day-level situational motivation for physical activity using a customized mobile app made by a no-code app development platform; and 2) describe two levels of motivation (contextual and situational) in WAT users using the hierarchical model of motivation. The presenters hypothesized that they would identify distinct motivational profiles and that those profiles would predict differing levels of situational motivation. Collecting situational motivation for physical activity was feasible using a no-code mobile platform. WAT users vary in their contextual motivational profile for physical activity and these predict some types of situational motivation. They suggested that future research should further investigate physical activity motivation in WAT users to identify intervention opportunities. 

Presentation 3: Symposium 2

“Implementing Mobile Health Interventions and Observational Studies Using a No-code App Development Platform”

Presenters: Dr. Denver Brown, Dr. Sam Liu, Dr. Kayla Nuss, and Ms. Amanda Willms

Mobile health (mHealth) technology holds tremendous potential to deliver behavior health interventions and understand human behavior. However, a challenge facing researchers when conducting mHealth research is the resources required to develop and maintain mHealth apps. Specifically, a no-code mHealth research app development platform may enable researchers with no previous software programming skills to create apps through a graphical user interface. In this symposium, presenters discussed how a no-code app development platform, was created and used to co-design and implement physical activity mHealth interventions and conduct longitudinal observational studies to understand physical activity behavior. The first presenter provided an overview of the no-code mHealth research platform and discussed its development and usability testing. The second presenter discussed how the platform was used to co-design adaptive mHealth physical activity interventions. Dr. Nuss discussed how the platform was used to implement a daily diary study to examine changes in situational motivation for physical activity based on contextual motivational profile in current wearable activity tracker users over a 14-day period. The final presenter discussed how the platform was used conduct a longitudinal feasibility study examining the influence that first-year roommates have on one another’s device-measured physical activity behavior during the transition to university which included weekly surveys to capture dyadic relations.

Presentation 4: Paper Session

“Reflecting on Physical Activity across Two Years of the COVID-19 Pandemic: Predictors if Intention-Behavior Profiles”

Presenter: Dr. Ryan Rhodes

Co-authors: Dr. Sam Liu, Dr. Kayla Nuss, and Dr. Wuyou Sui

The COVD-19 Pandemic has affected how many people engage in regular moderate-to-vigorous intensity physical activity (MVPA). Understanding the correlates of various motivational and behavioral profiles is important to producing effective interventions. The purpose of this study was to predict current and dynamic (across two years of the COVID-19 Pandemic) intention and MVPA profiles using the multi-process action control (M-PAC) framework. Few participants increased MVPA across the pandemic and dynamic patterns of intention-MVPA profiles by pre-pandemic MVPA showed the presence of two at risk groups (relapsed non-intenders relapsed unsuccessful intenders) who have relapsed in MVPA. Collectively, the findings support the joint promotion of reflective regulatory and reflexive processes in the choice of behavior change techniques to promote post-pandemic MVPA intention and behavior. 

A Protocol for Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students

A Protocol for Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students

A research team led by Dr. Anne Ray from the University of Kentucky, and including Dr. David Buller from Klein Buendel, has published (online ahead of print) the protocol for  an active research project in JMIR Research Protocols. The study is designed to curb drinking and risky sexual behavior by first-year college students using an innovative, cross-tailored, dynamic feedback (CDF) component. The intervention purposefully integrates content on the relationship between alcohol use and risky sexual behavior and leverages technology to incorporate daily assessments of student behavior and deliver weekly dynamic feedback.

Two-thirds of college students are current drinkers of alcoholic beverages. One in three college students report past month binge drinking (five or more drinks in a row), and one in ten report high intensity drinking (ten or more drinks in a row). Greater student alcohol consumption and heavy drinking on a given day are linked to increased sexual activity and risky sexual behavior, such as unprotected sex and sex with casual partners. This puts students at risk for negative health outcomes, such as sexually-transmitted infections, and other harmful consequences, such as sexual victimization.

A hybrid effectiveness-implementation design will allow the investigators to evaluate the effectiveness of the integrated personalized feedback intervention (PFI) with 600 first-year college students at two college sites in a randomized controlled trial. In addition, formative evaluation with local and national stakeholders (such as students and student affairs staff) will help to better understand factors that influence implementation and ensure its success and sustained use.

According the paper’s abstract: “This study utilizes a hybrid type 1 effectiveness-implementation design and will be conducted in three phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In Phase 2, 600 first-year college students who drink and are sexually active will be recruited from two sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months postbaseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors.” Intervention, recruitment, and implementation plans are described in JMIR Research Protocols.

This research is supported by a grant from the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (AA028246; Dr. Anne Ray, Principal Investigator). Collaborators include Dr. David Buller (Co-Investigator) from Klein Buendel. Klein Buendel’s Creative Team is developing the technology-delivered program for college students.