Physical Activity Intervention for Older Adults

Physical Activity Intervention for Older Adults

In a publication in the Journal of the American Geriatrics Society, Dr. Nancy Glynn from the University of Pittsburgh, Klein Buendel’s Senior Scientist Dr. Valerie Myers, and several other contributors evaluate the effectiveness of the Lifestyle Interventions and Independence for Elders (LIFE) study.

The LIFE study was a randomized controlled trial designed to compare a moderate-intensity physical activity intervention with a health education program for sedentary older persons, 65 years or older, with low physical activity who are at risk for major mobility disability. LIFE’s primary goal was to investigate whether physical activity is an effective and practical way for preventing major mobility disability in older persons, which is defined as the inability to walk 400 meters.

For the study, participants at multiple centers were asked to perform a 400-meter walk at a normal pace every six months at which various measurements were assessed and calculated including baseline fatigue, self-reported fatigue, and energy levels. The physical activity intervention incorporated lower extremity resistance exercises, balance exercises, stretching and behavioral counseling. Health education seminars were also provided with information available about health-related matters and involved various upper extremity stretching exercises.

To learn more about the physical activity intervention and if it was effective at preserving the mobility of older adults, you can view a full description of the methods, results, and discussion in the publication.

This research was funded by a grant from the National Heart, Lung, and Blood Institute and the National Institute on Aging (AG022376; Marco Pahor, MD, University of Florida, Principal Investigator). Dr. Myers is one of the paper’s 16 authors, including the Interventions and Independence for Elders Study Group.

Hispanic Tattoo Artists as Skin Cancer Prevention Influencers

Hispanic Tattoo Artists as Skin Cancer Prevention Influencers

Skin cancer is increasing in the Hispanic population and there is a public health need for campaigns to target this often-underrepresented population. In a recent publication in The Journal of Drugs in Dermatology (JDD), authors from the University of Colorado School of Medicine and Klein Buendel examine how Hispanic tattoo artists can serve as skin cancer prevention advocates for the Hispanic population. JDD also released a podcast with the authors about the study earlier this month.

Multiple in-depth interviews were conducted with Hispanic tattoo artists at various tattoo studios in Salt Lake City, Utah. The interviews provided insight into the artist’s skin cancer knowledge, their current sun safety recommendations to clients, and their willingness to incorporate skin cancer prevention into their future work routines.

Data analysis indicated that a most of the artists had a large percentage of Hispanic clients and repeat customers. All artists also had some level of skin cancer knowledge, though not extensive enough to provide basic sun protection tips in their regular tattoo aftercare instructions to clients (such as what specific Sun Protection Factor to use, when to reapply sunscreen, and the use of cover up clothing). Despite this, all artists were enthusiastic about providing sun safety messages on their social media pages and would be willing to partake in some level of skin cancer prevention training and education in the future.

With lengthy tattoo sessions and repeat clientele, Hispanic tattoo artists could serve as beneficial influencers in the early detection of skin cancers in the Hispanic population. Researchers concluded that by providing comprehensive full-body sun protection information to their clients through tattoo aftercare instructions, alerting clients to suspicious moles, and using social media messages, Hispanic tattoo artists could have a big impact on their clients’ skin health. The study’s complete analysis and discussion can be found in the publication.

This project was funded by a grant and a supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Authors include Dr. Cristian Gonzalez, and Dr. Adrian Pona from the University of Colorado School of Medicine; Dr. Barbara Walkosz from Klein Buendel; and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the U.S. Department of Veterans Affairs Rocky Mountain Regional VA Medical Center Dermatology Service.

Project SHINE for Adolescent Tanning Prevention

Project SHINE for Adolescent Tanning Prevention

Dr. David Buller, Klein Buendel Director of Research, is a Co-Investigator on a new research project funded by the National Cancer Institute and being led by Dr. Yelena Wu, Principal Investigator, from the University of Utah. Project SHINE (Sun-safe Habits Intervention and Education) is a multi-modal intervention that targets adolescents’ views on the personal relevance of skin cancer and their ability to prevent the disease in order to increase their sun protection use and decrease their intentional tanning.

Project SHINE incorporates action plans, sun damage photographs, and education to teachers and parents in order to build on adolescents’ interest in novelty and need for highly personalized interventions. It also promotes environmental supports for adolescent skin cancer prevention. SHINE is novel in its application of the Extended Parallel Process Model, used in smoking and drug abuse interventions, to pediatric skin cancer prevention. The five-year study will be conducted with 30 high schools and over 10,000 students in 9th or 10th grade health classes. To support the rigor of this research, the project will objectively measure ultraviolet radiation (UVR) exposure among 10% of the sample who will wear a UVR monitoring device for 3-day periods after self-reported assessments.  

Dr. Buller is part of a well-established team that includes experts in skin cancer prevention, adolescent health behavior change, dermatology, school programs, and randomized trials. He will provide input on the design and implementation of the study, help develop parent/teacher education materials, and participate in results interpretation and manuscript preparation.

Skin cancer is a significant public health priority. It is the most commonly diagnosed form of cancer, afflicting more than 5 million people in the United States each year. Treatment costs total more than $8 billion each year. Skin cancer is highly preventable if individuals limit UVR exposure by using sun protection strategies, such as sunscreen, hats, protective clothing, and by avoiding tanning. Use of prevention strategies is critical during childhood and adolescence, when skin cells are particularly vulnerable to UVR damage leading to skin cancer. Due to their poor use of sun protection and likelihood to intentionally tan, adolescents, more than any other pediatric group, urgently need efficacious skin cancer preventive interventions. Schools offer the ideal setting to deliver skin cancer preventive interventions to large numbers of adolescents.

Spotlight:
Dr. Hilton Hudson

Spotlight:
Dr. Hilton Hudson

Hilton M. Hudson, MD, FACS, of HPC International, Inc. (HPC), is a Co-Investigator on a SBIR Phase II research project with Dr. Valerie Myers (Principal Investigator) from Klein Buendel called, “Pinpoint: Gaming Technology to Engage Adolescent Sickle Cell Patients in Precision Pain Management. The project is funded by the National Institute of Minority Health and Health Disparities (MD010746) at the National Institutes of Health. As an African American, a surgeon, a researcher, and the CEO of a publishing company, the effective management and treatment of sickle cell disease is very important to Dr. Hudson. In fact, HPC is the publisher of two preeminent books on sickle cell disease for the public: Hope and Destiny for adults and Hope and Destiny, Jr. for adolescents.

Dr. Hudson is one of less than 40 board-certified, African-American cardiothoracic surgeons currently practicing in the United States. He is a partner of the Institute of Cardiothoracic and Vein Surgery, LLC in Illinois and serves on the Board of Directors for the Healthcare Supplier Diversity Alliance. During his 25+ years of practicing medicine, Dr. Hudson has also served as Chairman of the Board at Heartland Hospital in Munster, Indiana and as the Chief of Cardiothoracic Surgery at the Franciscan Physicians Hospital in Munster, Indiana.

With respect to his research experience and publications, Dr. Hudson is perhaps best known for authoring and publishing the successful book, “The Heart of the Matter: The African American’s Guide to Heart Disease, Heart Treatment, and Heart Wellness,” in 2000, which has subsequently been revised and translated into Spanish with total collective sales of over 75,000 copies.

In addition to practicing medicine, Dr. Hudson is the President and CEO of HPC International, Inc. (formerly the Hilton Publishing Company, Inc.), which he co-founded in 1996 to publish trusted content that can improve the health, education, awareness and wellness of health disparate and other underserved populations. “Around that time,” recalls Dr. Hudson, “I started practicing medicine as a cardiothoracic surgeon and immediately noticed an unfortunate but quite obvious correlation between the socio-economic, racial and gender status of my patients and subpar health. Patient after patient from these community groups lacked the education to teach them how simple changes to their daily habits and health routines could significantly reduce many of their risks for heart issues and other chronic diseases. I spent a lot of time researching what information was available for patients, and discovered a critical gap — a need for new health literature that would be culturally meaningful, evidence-based and impactful for improving the state of health in our health disparate populations. When multiple publishers declined to publish the book for me, I started a new company to do it myself!”

Born in Indianapolis, Indiana, Dr. Hudson is a graduate of Wabash College in Crawfordsville, Indiana, where he earned a Bachelor of Arts degree with honors in English and Math in 1980. He earned his medical degree at Indiana University Medical Center in 1987. Dr. Hudson then completed his Cardiovascular Surgery Extern at Methodist Hospital and his residency for General Surgery at Boston City Hospital and Boston University Hospital before serving in the U.S. Army Medical Corps from 1992-1998. During his years in the military, Dr. Hudson completed a fellowship for Cardiothoracic Surgery at Ohio State University in Columbus. That was 1994, just two years before he founded HPC.

In 2014, HPC started a new affiliated company called EMIC LLC (Evidence-based Medical Information Company) to disseminate evidence-based products and e-health programs on technology platforms to facilitate positive health behavior, empower patients with trusted evidence-based information, and improve the quality of healthcare.

Dr. Hudson has received many distinguished awards and honors throughout his career, including:

  • The Sagamore of the Wabash Award for Distinguished Service in Minority Health which he received from the Governor of Indiana in 2000;
  • A Nomination for the Humanitarian Award by the International Society on Hypertension in Blacks in 2003; and
  • The Award for Achievement in Health in the State of Indiana which was presented to him by Governor Mitch Daniels in 2008.

Health Chat Presentation for NCI

Health Chat Presentation for NCI

Dr. David Buller from Klein Buendel presented initial findings from an ongoing social media campaign for mothers to improve adolescent health and reduce indoor tanning, called Health Chat, via webinar to the Health Communication and Informatics Research Branch of the National Cancer Institute on December 10, 2019.

Despite the substantial risk of skin cancer from indoor tanning, it remains popular among older adolescent females aged 14-17 and mothers aged 27-45. The CDC1 and the Surgeon General2 have set a national goal of reducing indoor tanning by teens and public policies restricting indoor tanning are increasing. However, many states still allow minors to indoor tanning, with varying forms of restriction.3 

Because mothers’ permissiveness of indoor tanning and her own indoor tanning are strong predictors of adolescent daughters indoor tanning, and many daughters initiate indoor tanning with their mother, the research team developed a program aimed at moms in an effort to reduce indoor tanning by minors. A multi-faceted adolescent health and wellness campaign was created to be delivered through Facebook private groups that included messages on indoor tanning prevention, prescription drug misuse, vaccinations, healthy lifestyles, substance use, mother-daughter communication, and more. Mothers (n=869) were in the groups for one year and received messages daily. Mothers and their daughters completed surveys at baseline and 12-month follow-up, and 18-month follow-up surveys are currently underway.

Dr. Buller reported on how the Health Chat program was created, the potential of using social media for research, campaign engagement measures, and initial findings from the 12-month follow-up survey of mothers and daughters. He shared methodological challenges that arose from using Facebook private groups such as Facebook algorithms changing, the inability for participants to share content outside of the groups, and logistical barriers of adding participants to groups. He also shared plans for coding user-generated content,4 including hundreds of comments left by mothers on the Facebook posts. Full results should be published in 2020.

This research was funded by a grant to Klein Buendel from the National Cancer Institute [CA192652; Dr. David Buller and Dr. Sherry Pagoto (from the University of Connecticut), Multiple Principal Investigators]. Co-Investigators include Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University, and Dr. Kimberly Henry from Colorado State University.

References

1. Healthy People 2020 – topics & objectives. Office of Disease Prevention and Health Promotion Web site. Available at: https://www.healthypeople.gov/2020/topics-objectives. Published 2012. Accessed December 17, 2019.

2. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Surgeon General; 2014.

3. National Conference of State Legislatures. Indoor tanning restrictions for minors: A state-by-state comparison. National Conference of State Legislatures Web site. Available at: http://www.ncsl.org/research/health/indoor-tanning-restrictions.aspx. Published May 20, 2019. Accessed December 17, 2019.

4. Buller D, Walkosz B, Berteletti J, et al. Insights on HPV vaccination in the United States from mothers’ comments on Facebook posts in a randomized trial. Hum Vaccin Immunother. 2019;15(7-8):1479-1487. doi: 10.1080/21645515.2019.1581555

Klein Buendel’s 2019 Research Highlights

Klein Buendel’s 2019 Research Highlights

In our 17th year, Klein Buendel scientists and staff continue to conduct rigorous behavioral science research with numerous collaborators from across the country. In 2019, our investigators published 15 new research manuscripts in peer-reviewed journals and presented their research findings via 18 posters and presentations at 10 local, national, and international conferences and expert meetings. One of our posters was nominated for Best Poster in the Prevention and Public Health division at the Science of Dissemination and Implementation in Health annual conference, and one of our papers was selected by its journal to be included in their December 2019 Continuing Medical Education (CME) exam.

In April 2019, KB opened a new satellite research office in Albuquerque, New Mexico. The office is led by Dr. Gill Woodall, KB Senior Scientist, and conducts research projects with southwestern populations. 

Dr. Valerie Myers, KB Senior Scientist, was appointed this year by the Board of Directors of the Society of Behavioral Medicine to serve as the Education, Training, and Career Development Committee Chair. Her three-year term will begin in April of 2020.

In March of 2019, Dr. Barbara Walkosz, KB Senior Scientist, lectured on Media Literacy and Health Communication at Beijing Normal University in China. Dr. Walkosz also serves as an appointed Commissioner for Denver Mayor Michael Hancock’s Commission on Aging, part of the Agency for Human Rights and Community Partnerships.

In April of 2019, Dr. David Buller, KB Director of Research, lectured on KB’s occupational sun protection research (Sun Safe Workplaces) in a class at the University of Colorado School of Medicine. And in December, he presented initial findings from an ongoing social media campaign for mothers to improve adolescent health and reduce indoor tanning (Health Chat) via webinar to the Health Communication and Informatics Research Branch of the National Cancer Institute.

In product news, we licensed our Train to Tend® responsible marijuana vendor training program to Avid Will LLC for marketing and sales have started to take off. Also, sales of the very successful Way To Serve® responsible alcoholic beverage server training program continue to accelerate. And in September, we made one of our long-time products – the Grow, Eat Thrive elementary school nutrition and gardening curriculum – available for free online.

Lastly, KB was recognized in 2019 as #47 on Colorado Biz Magazine’s Top 100 Woman-Owned Companies list, and was #130 on their Top 200 Private Companies list.

Here’s to a Very Healthy and Happy New Year!

Publications

  • Byrnes HF, Miller BA, Grube JW, Bourdeau B, Buller DB, Wang-Schweig M, Woodall WG. Prevention of alcohol use in older teens: A randomized trial of an online family prevention program. Psychol Addict Behav. 2019 Feb;33(1):1-14. doi: 10.1037/adb0000442.
  • Buller MK, Bettinghaus EP, Fluharty L, Andersen PA, Slater MD, Henry KL, Liu X, Fullmer S, Buller DB. Improving health communication with photographic images that increase identification in three minority populations. Health Ed Res. 1 Apr 2019;34(2):145-158.
  • Kitt-Lewis E, Loeb SJ, Myers VH, Wion RK, Baney B, Strickfaden S. Developing educational modules to enhance care of aged and dying inmates: Set-up phase. Public Health Nurs. 2019;36(11): 401-410.
  • Buller DB, Walkosz BJ, Berteletti J, Pagoto SL, Bibeau J, Baker K, Hillhouse J, Henry KL. Insights on HPV vaccination in the United States from mothers’ comments on Facebook posts in a randomized trial. Hum Vaccin Immunother. 2019;15(7-8):1479-1487.
  • Buller DB, Walkosz BJ, Woodall WG. Use of media and social media in the prevention of substance abuse. In: Sloboda Z, Petras H, Robertson E, Hingson R, eds. Prevention of Substance Use. Cham, Switzerland: Springer Nature Switzerland AG; 2019 pp 319-334.
  • Newton RL Jr, Carter L, St. Romain J, Jerrod T, Griffith D, Myers V. Development of a mobile phone app to maintain physical activity in African American men: MobileMen. mHealth. 2019 Jun 13;5:16. doi: 10.21037/mhealth.2019.05.03. eCollection 2019.
  • Kitt-Lewis E, Loeb SJ, Wion RK, Myers VH, Jerrod T, Strickfaden S. Developing Computer-Based Learning on Care of Aged and Dying Incarcerated People. J Forensic Nurs. 2019 Jul 9. doi: 10.1097/JFN.0000000000000248. [Epub ahead of print]
  • Byrnes HF, Miller BA, Bourdeau B, Johnson MB, Buller DB, Berteletti J, Rogers VA. Prevention of alcohol and other drug overuse among nightclub patrons: a randomized trial of a group-based mobile intervention at nightclubs. J Stud Alcohol Drugs. 2019 Jul;80(4):423-430.
  • Walkosz B, Buller D, Buller M, Wallis A, Liu X. Senior managers’ awareness of sun protection policy predicts implementation of worksite sun safety in a randomized trial. Am J Ind Med. 2019 Oct;62(10):893-900.
  • Meenan RT, Walkosz BJ, Buller DB, Eye R, Buller MK, Wallis AD, Olivas S. Economic evaluation of an intervention promoting adoption of occupational sun protection policies. J Occup Environ Med. 2019 Dec 6;61(12):978-983.*

*The above paper was selected by JOEM as an article to be included in their December 2019 CME exam.

  • Gonzalez CD, Rundle CW, Pona A, Walkosz BJ, Dellavalle RP. Ultraviolet radiation may cause premature fading of colored tattoos. Photodermatol Photoimmunol Photomed. 2019 Aug 28. doi: 10.1111/phpp.12509. [Epub ahead of print]
  • Buller DB, Woodall WG, Saltz R, Buller MK. Compliance with ID regulations by recreational marijuana stores in two US states. J Stud Alcohol Drugs. J Stud Alcohol Drugs. 2019 Nov;80(6):679-686.
  • White KAM, Dailey YT, Guest DD, Zielaskowski K, Robers E, Sussman A, Hunley K, Hughes CR, Schwartz MR, Kaphingst KA, Buller DB, Hay JL, Berwick M. MC1R variation in a New Mexico opulation. Cancer Epidemiol Biomarkers Prev. 2019 Nov;28(11):1853-1856.
  • Gonzalez CD, Pona A, Walkosz BJ, Dellavalle RP. Hispanic Tattoo Artists Could Provide Skin Cancer Prevention via Aftercare and Social Media. J Drugs Dermatol. ; 2019 Dec 1;18(12):1237-1243.
  • Glynn NW, Gmelin T, Santanasto AJ, Lovato LC, Lange‐Maia BS, Nicklas BJ, Fielding RA, Manini TM, Myers VH, de Rekeneire N, Spring BJ, Pahor M, King AC, Rejeski WJ, Newman AB; for the Lifestyle Interventions and Independence for Elders Study Group. Impact of baseline fatigue on a physical activity intervention to prevent mobility disability. J Am Geriatr Soc. 2019 Dec 22. doi:10.1111/jgs.16274. [Epub ahead of print]

Conference Presentations

Society of Behavioral Medicine Annual Meeting: March 6-9 in Washington, DC

  • Berteletti J, Buller DB, Pagoto S, Walkosz B, Bibeau J, Baker K, Hillhouse J, Henry K. Mothers’ beliefs about adolescent marijuana use: insights from a Facebook-delivered intervention and randomized trial. Oral presentation.
  • Reynolds KD, Buller DB, Buller MK, Massie K, Berteletti J, Ashley J, Meenan RT. Randomized trial evaluating an intervention supporting implementation of sun safety policies in public elementary schools. Oral presentation.
  • Myers VH, Loeb SJ, Kitt-Lewis E, Wion R, Murphy J, Jerrod T, Carter M. E-training of Inmate Peer Caregivers for Enhancing Geriatric and End-of-Life Care in Prisons. Oral presentation.
  • Bibeau JL, Berteletti J, Goetz JM, Massie K. Using project management skills in behavioral research. Pre-conference workshop presentation.

American Society of Preventive Oncology Annual Meeting: March 10-12 in Tampa, Florida

  • Myers V. Technology and Health Behavior: Crossing the Digital Divide. Oral presentation.

Eastern Nursing Research Society Annual Meeting: April 3-5 in Providence, Rhode Island

  • Loeb SJ, Kitt-Lewis E, Myers VH, Wion R, and Murphy J, Jerrod T, Carter M. Inmate Caregiver Training in Geriatrics and End-Of-Life. Oral presentation.

DC Health Communication Conference: April 25-27 in Fairfax, Virginia

  • Buller D. Grant Writing 101: Boot Camp with NIH. Pre-conference workshop presentation.

Society for Prevention Research Annual Meeting: May 28-31 in San Francisco, California

  • Byrnes H, Miller B, Bourdeau B, Johnson MB, Buller DB, Berteletti J, and Rogers V. Group cohesion among social drinking groups at nightclubs and risk from alcohol and other drug use. Poster presentation.
  • Miller B, Byrnes H, Rogers V, Bourdeau B, Grube J, Johnson MB, Buller DB, Berteletti J. Group-based intervention for overuse of alcohol in a high-risk context: Examining the influence of group gender composition on outcomes. Poster presentation.
  • Saltz R, Buller D, Woodall WG, Grayson A. Refusal of pseudo-intoxicated customers by retail marijuana outlets in three U.S. states. Poster presentation.

Kettil Bruun Society Annual Meeting: June 3-7 in Utrecht, Netherlands

  • Woodall WG, Buller DB, Saltz R, Perez F, Chacon-Silva A, Sanchez V, Reither J, Starling R, Diaz L. WayToServe Español: A web-based responsible beverage service training for Spanish-speaking alcohol servers. Oral presentation.

National Research Society on Alcoholism Annual Scientific Meeting: June 22-26 in Minneapolis, Minnesota

  • Woodall WG, Saltz R, Buller D, Perez F, Chacon Silva A, Sanchez V, Starling R. Refusal of alcohol sales to pseudo-intoxicated patrons in primarily Spanish-speaking premises: A tale of two states. Oral presentation.

North American Association of Transportation Safety and Health Officials Annual Conference: September 8-12 in New Orleans, Louisiana

  • Grayson A. Go sun smart at work. Oral presentation.

European Society for Prevention Research Conference: September 16-18 in Ghent, Belgium

  • Buller D, Woodall WG, Saltz R, Grayson A, Svendsen S, Buller M. Effects of an online responsible vendor training for recreational cannabis stores on sales to pseudo-intoxicated customers: need for increased deterrence. Oral presentation. 
  • Miller B, Byrnes H, Rogers V, Bourdeau B, Grube J, Buller D, Woodall WG, Berteletti J. A family-based program to reduce teen alcohol use and risky sexual behavior. Oral presentation. 
  • Woodall WG, Miller B, Buller D, Byrnes H, Bourdeau B, Grube J, Rogers V, Berteletti J. Effect of teen engagement with a family-based online intervention on reduction in alcohol use by teens. Poster presentation.

The Science of Dissemination & Implementation in Health Conference: December 4-6 in Washington, DC

  • Buller DB, Reynolds KD, Buller MK, Meenan R, Ashley J, Berteletti J, Massie K. An implementation intervention for school sun safety policies increased parents’ reports of sun safety communication from schools and children’s sun protection. Oral presentation.
  • Buller DB, Walkosz B, Buller M, Meenan R, Eye R, Grayson A, Olivas S. An Implementation Model for the Cost-effective Scale-up of the Sun Safe Workplaces Program. Poster presentation.*

*The above poster was nominated for Best Poster in the division of Prevention and Public Health at the Science of Dissemination & Implementation in Health Conference.

ID Compliance by Recreational Marijuana Stores in Two States

ID Compliance by Recreational Marijuana Stores in Two States

The recreational sale of marijuana has begun in ten U.S. states and seems likely to expand to several others. Only state-licensed stores can sell recreational marijuana products and only persons over age 21 who provide a valid state-approved identification (ID) can enter the stores and purchase marijuana. The age and ID regulations are intended to prevent youth gaining access to recreational marijuana, and it is important to investigate whether these age and ID restrictions are actually working.

Research collaborators from Klein Buendel and the Pacific Institute for Research and Evaluation, measured compliance with age and ID regulations by state-licensed recreational marijuana stores in two states and reported their findings in the Journal of Studies on Alcohol and Drugs. The paper reports assessment of sale refusal rates in a large, diverse sample of stores selling recreational marijuana in the states of Colorado and Washington. The paper’s analyses describe ID checking behavior by store personnel, estimate refusal rates, and explore factors associated with refusal. 

One hundred seventy-five recreational marijuana stores in Colorado and Washington were visited twice by pseudo-buyer assessment teams in September 2016 to April 2017. A young-adult buyer attempted to enter the store and purchase marijuana without showing a state-approved identification. In the second Colorado visit, a buyer aged 18-20 showed an underage driver’s license and attempted to enter the store and purchase marijuana. No cannabis products were actually purchased.

All stores requested an ID. Stores refused buyers in 73.6% of visits at the entrance, 88.3% cumulative before the counter, and 92.6% cumulative by the time of a purchase attempt. Refusal was lower in Washington than in Colorado but it did not differ by buyer protocol. Overall, compliance with laws restricting marijuana sales to individuals 21 or older with a valid ID was high. The authors suggest that compliance in Washington might be improved by having store personnel check IDs at the store entry. Recreational stores may not be selling marijuana directly to youth, although no information was collected on straw purchases. The measures, methods, analyses, results, conclusions, and limitations are detailed in the publication.

This research was funded by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Coauthors include Dr. Gill Woodall and Ms. Mary Buller from KB, and Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation.

An Implementation Model for the Cost-effective Scale-up of the Sun Safe Workplaces Program

An Implementation Model for the Cost-effective Scale-up of the Sun Safe Workplaces Program

Dr. David Buller and Dr. Barbara Walkosz from Klein Buendel presented a poster on a new implementation model for the cost-effective scale-up of an occupational sun protection program at the 12th Annual Conference on the Science of Dissemination and Implementation in Health in Washington, DC, December 4-6, 2019. The poster was nominated for Best Poster from the Prevention and Public Health Division.

Scale-up is the effort to increase the impact of successful programs to benefit more people on a lasting basis. Scale-up efforts must increase reach, retain effectiveness, and lower costs to provide greater access to benefits and close the research-to-practice gap between effective programs and real-world application. This project is studying the nationwide scale-up of an occupational sun safety intervention, Sun Safe Workplaces, with state Departments of Transportation (DOTs), a public works sector with thousands of outdoor workers.

Costs of national distribution can be daunting and influence intervention intensity and program effectiveness. Identifying cost-effective scale-up strategies is essential for moving research into practice. The new framework draws upon existing implementation models, including those developed for occupational health and safety, and operationalizes implementation for scale-up within RE-AIM. The RE-AIM framework was adapted for this new framework by incorporating cost as a primary factor.

In a randomized trial, Sun Safe Workplaces (SSW) is assessing implementation rate and costs associated with two methods of scaling-up SSW. The original intervention depended on personal visits with managers, materials promoting sun protection policies and education, in-person sun safety training for employee groups, and on-going follow-up communication with managers supporting sun safety (SSW-IP), a resource-intensive form of intervention. Now SSW-IP is being contrasted to a scale-up strategy that uses web-based and telephone conferencing, responsive training platforms, and electronic resources for virtual contacts and training (SSW-T). Technology-based programs have the potential to deliver standardized, engaging content and increase portability while decreasing cost of delivery to enable reaching more employers when scaled-up to nationwide distribution. Districts within DOTs are randomized to one of the two scale-up methods. The SSW-IP and SSW-T interventions are being delivered in 21 state DOTs with 141 districts.

This research is funded by a grant from the National Cancer Institute (CA134705; Dr. David Buller and Dr. Barbara Walkosz, Multiple Principal Investigators). Additional poster coauthors include Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; and Mary Buller, Rachel Eye, Andrew Grayson, and Savanna Olivas from Klein Buendel.

Parents’ Reports of School Communication on Sun Safety

Parents’ Reports of School Communication on Sun Safety

The U.S. Surgeon General and the Centers for Disease Control and Prevention have called on the nation’s schools to help prevent skin cancer by implementing sun safety practices and policies. The Sun Safe Schools program was designed by Klein Buendel researchers and collaborators in response to those calls to action. The program was implemented and evaluated with 118 public elementary schools in California.

Dr. David Buller, Klein Buendel Director of Research, presented data on the impact of the Sun Safe Schools intervention on parents’ reports of sun safety communication from schools and children’s sun protection behavior at the 12th Annual Conference on the Science of Dissemination and Implementation in Health in Washington, DC, December 4-6, 2019.

Schools randomized to the Sun Safe Schools intervention group (N=58) received support for implementing school sun safety practices by trained coaches over 20 months. Based on Diffusion of Innovations Theory, support and resources for implementation were tailored to school principals’ readiness to implement. Parents completed an online posttest survey through invitations sent by principals or while attending parent-oriented school events. Parents were surveyed to test the hypothesis that parents would report more communication about sun safety at schools receiving the intervention than at control schools.

The Sun Safe Schools program appeared to increase communication on sun safety and the use of student sun protection. Parents in intervention schools were more likely to report receiving information about sun safety from the school and that their children wore sun-protective clothing than in control schools. The improvement in sun safety appeared to result from policy implementation. In schools where principals reported implementing sun safety practices at posttest, parents reported that children spent less time outdoors and had fewer sunburns than at non-implementing schools. Further, parents who received information about sun safety from the school reported more sun protection for their child than parents not receiving the information.

In summary, a school district-level policy, combined with active technical support for schools within the district, appears to be effective at increasing implementation of school sun safety practices to help protect children from solar ultraviolet radiation, the primary risk factor for the development of skin cancer.

The Sun Safe Schools program is a joint research effort of Claremont Graduate University (CGU), the Kaiser Permanente Center for Health Research, and Klein Buendel. The research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds, CGU, and Dr. David Buller, Multiple Principal Investigators). Other collaborators included Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Kim Massie previously from Chapman University; and Julia Berteletti and Mary Buller from Klein Buendel.