ezPreemie Project

ezPreemie Project

Today, 80-90% of very preterm infants survive. However, preterm birth alters the development of the prefrontal cortex, the brain region heavily involved in behavior regulation and inhibition. This places children born very preterm at high risk for developmental delays and behavioral problems.

Early prevention and intervention can interrupt the development of problem behaviors, reduce active problem behaviors and improve functioning for children and families. Behavioral parent training (BPT) is a gold standard for prevention and treatment of child behavior problems. BPT teaches child management skills and positive parenting strategies. Little is known about the use and effects of BPT programs for former very preterm infants with their unique medical, developmental, and psychological risk profiles.

A research team from Ohio State University, Rush University, Nationwide Children’s Hospital, and Klein Buendel is launching a 5-year research project to develop and evaluate a technology-based, widely accessible, and effective form of BPT delivery to address the unmet and unique needs of parents of very preterm children. The app will be tested alone and in combination with specialized coaching. The project is called “Parent Training for Parents of Toddlers Born Very Premature.” It is being led by Dr. Susie Breitenstein from Ohio State University (OSU) Dr. Michele Greene form Ruch University (Multiple Principal Investigators). the project funded by The Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD104072).

The research project will design and develop a web-based app, similar to one developed previously by Dr. Breitenstein and her team, called ezParent. ezParent was designed for parents of children ages 2-6. It provides behavioral training through brief vides, interactivity, reflection questions, and assessments to parents of young children. The new iteration of ezParent ezPreemie will assess the independent and combined effects of ezParent and coaching calls on parent and child outcomes in families with very preterm infants.

Dr. Breitenstein, PhD, RN, FNAP, FAAN, is an Associate Professor, Assistant Dean for Research and Innovation, and Senior Director, Community Outreach and Engagement & CHW Training Program in the OSU College of Nursing. Dr. Michelle Greene is an Associate Professor and Director of the Psychology Section in the Department of Pediatrics at Rush Medical College. Research Co-investigators include Dr. Michael Schoeny and Dr. Kousiki Patra from Ruch University, Dr. Sarah Keim and Dr. Mary Lauren Neel from Nationwide Children’s Hospital, and Ms. Julia Berteletti from Klein Buendel. The ezPreemie app will be engineered by Klein Buendel’s Creative Team.

2021 Research Highlights

2021 Research Highlights

Klein Buendel (KB) scientists and staff conducted rigorous behavioral science research with numerous collaborators from across the country in 2021. Our investigators published (or e-published ahead of print) 16 research papers in peer-reviewed journals and presented research findings virtually at 8 national or international conferences. In addition, our investigators are Principal Investigators or Co-Investigators on 6 new research projects that launched this year.


KB investigators, staff, and collaborators published or e-published the following research papers this year (current or recent investigators and staff are indicated in bold type):

Midgett A, Doumas DM, Myers VH, Moody S, Doud A. Technology-Based Bullying Intervention for Rural Schools: Perspectives on Needs, Challenges, and Design. Rural Ment Health. 2021 Jan;45(1):14-30. doi: 10.1037/rmh0000151.

Buller DB, Woodall WG, Saltz R, Grayson A, Buller MK, Cutter GR, Svendsen S, Liu X. Randomized Trial Testing an Online Responsible Vendor Training in Recreational Marijuana Stores in the United States. J Stud Alcohol Drugs. 2021 Mar;82(2):204-213.

Lee H, Henry KL, Buller DB, Pagoto S, Baker K, Walkosz B, Hillhouse J, Berteletti J, Bibeau J. Mutual influences of mother’s and daughter’s mental health on the closeness of their relationship: an actor-partner interdependence model. J Child Fam Stud. 2021 Mar;30:676-686.

Buller DB, Walkosz BJ, Olivas S, Eye R, Liu X, Kinsey A, Buller MK, Grayson A. Association of Occupational Sun Safety Policy and Actions in State Transportation Sector in the United States. Am J Ind Med. 2021 Apr;64(4):274-282. doi: 10.1002/ajim.23214.

Buller DB, Pagoto S, Baker K, Walkosz BJ, Hillhouse J, Henry KL, Berteletti J, Bibeau J. Results of a Social Media Campaign to Prevent Indoor Tanning by Teens: A Randomized Controlled Trial. Prev Med Rep. 2021 Apr 18;22:101382. doi: 10.1016/j.pmedr.2021.101382. eCollection 2021 Jun.

Heckman CJ, Buller DB, Stapleton JL. A call to action to eliminate indoor tanning: focus on policy [published online ahead of print April 28, 2021]. JAMA Dermatol. doi: 10.1001/jamadermatol.2021.0874.

Loeb SJ, Murphy JL, Kitt-Lewis E, Wion RK, Jerrod T, Myers VH. Inmates Care: computer-based training for geriatric and end-of-life care in prisons. J Correct Health Care. 2021 Jun;27(2):132-144. doi: 10.1089/jchc.20.03.0016.

Bourdeau B, Miller BA, Byrnes HF, Woodall WG, Buller DB, Grube JW. Efficacy of a web-based intervention (Smart Choices 4 Teens) for facilitating parent-adolescent communication about relationships and sexuality: randomized controlled trial. JMIR Pediatr Parent 2021 Jun 15;4(2):e19114. doi: 10.2196/19114.

Banerjee SC, Sussman A, Schofield E, Guest DD, Dailey YS, Schwartz MR, Buller DB, Hunley K, Kaphingst KA, Berwick M, Hay JL. “Let’s talk about skin cancer”: examining association between family communication about skin cancer, perceived risk, and sun protection behaviors. J Health Commun. 2021 Aug 3;26(8):576-585. doi: 10.1080/10810730.2021.1966686.

Riley KE, Sussman AL, Schofield E, Guest DD, Dailey YT, Schwartz MR, Buller DB, Hunley K, Kaphingst KA, Berwick M, Hay JL. Effect of superstitious beliefs and risk intuitions on genetic test decisions [published online ahead of print August 28, 2021]. Med Decis Making. doi: 10.1177/0272989X211029272.

Hay JL, Kaphingst KA, Buller D, Schofield E, Meyer White K, Sussman A, Guest D, Dailey YT, Robers E, Schwartz MR, Li Y, Hunley K, Berwick M. Behavioral and psychological outcomes associated with skin cancer genetic testing in Albuquerque primary care. Cancers (Basel). 2021 Aug 12;13(16):4053. doi: 10.3390/cancers13164053.

Woodall WG, Zimet G, Kong A, Buller D, Reither J, Chilton L, Myers V, Starling R. Vacteens.org: a mobile web app to improve HPV vaccine uptake. Front Digit Health. 25 Aug 2021;3:693688. doi: 10.3389/fdgth.2021.693688.

Doumas DM, Midgett A, Myers V, Buller MK. Usability of a technology-based bystander bullying intervention for middle school students in rural, low-income communities: mixed methods study. JMIR Form Res. 2021;5(10):e32382. doi: 10.2196/32382.

Buller DB, Pagoto S, Henry K, Berteletti J, Walkosz BJ, Bibeau J, Baker K, Hillhouse J, Arroyo KM. Human papillomavirus vaccination and social media: results in a trial with mothers of daughters aged 14-17. Front Digit Health. 2021 Sept;3:683034. doi: 10.3389/fdgth.2021.683034.

Khan E, Kaphingst KA, Meyer White K, Sussman A, Guest D, Schofield E, Dailey YT, Robers E, Schwartz MR, Li Y, Buller D, Hunley K, Berwick M, Hay JL. Comprehension of skin cancer genetic risk feedback in primary care patients [published online ahead of print November 19, 2021]. J Community Genet. doi: 10.1007/s12687-021-00566-9.

Manne S, Kashy DA, Pagoto S, Peterson SK, Heckman CJ, Gallo J, Berger A, Buller DB, Kulik A, Frederick S. Family attitudes and communication about sun protection and sun protection practices among young adult melanoma survivors and their family members [published online ahead of print November 29, 2021]. J Health Commun. 2021:1-11. doi: 10.1080/10810730.2021.2008552.

Conference Presentations

KB investigators, staff, and collaborators gave research presentations and workshops at the following virtual conferences this year:

  • 33rd Annual Scientific Sessions of the Eastern Nursing Research Society (March 2021)
  • 14th Annual Academic and Health Policy Conference on Criminal Justice Health (April 2021)
  • DC Health Communication Conference (April 2021)
  • 42nd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine (April 2021)
  • 71st Annual Conference of the International Communication Association (May 2021)
  • 5th Annual Conference of the UConn Center for mHealth and Social Media (May 2021)
  • 5th International UV and Skin Cancer Prevention Conference (September 2021)
  • Custody and Caring: 17th Biennial International Conference on the Nurse’s Role in the Criminal Justice System (November 2021)

Lastly, once the COVID-19 vaccine was widely available, a handful of long-time KB senior employees decided to make professional and personal life changes. We said farewell to Pam Stevens, the Finance Director for 15 years; Dr. Valerie Myers, a Senior Scientist for 10 years; Lucia Liu, the Biostatistical Manager for 15 years; and Adam Ashby, the Senior Developer for 15 years. They will be missed.

Family Attitudes and Communication about Sun Protection

Family Attitudes and Communication about Sun Protection

Young melanoma survivors and their families are at increased risk for developing melanoma, yet do not often practice sun protection for skin cancer prevention. Currently, little is known about the role of family interaction in sun protection.

Klein Buendel Senior Scientist, Dr. David Buller, was one of several authors on a recent paper on family attitudes and communication about sun protection among young melanoma skin cancer survivors and their family members e-published in the Journal of Health Communication. The research team was led by Dr. Sharon Manne from the Department of Medicine, Behavioral Sciences Section at the Rutgers Cancer Institute of New Jersey.

The research team set out to “examine correspondence between survivors and family sun protection, individual attitudes, and family attitudes and communication about risk-reducing behaviors, and evaluate the mediating role of family attitudes and communication in the association between individual sun protection attitudes and behavior.” Participants completed questionnaires about their individual attitudes, family attitudes and communication, and sun protection behaviors.  

Analyses showed that families had varying levels of shared attitudes and behaviors. Family discussion was associated with higher sun protection for both men and women. Other findings differed for men vs. women and cancer survivors vs. family members. Full descriptions of the measures, methods, results, and conclusions can be found in the publication. Overall, the authors believe that family-focused interventions may prove effective because families’ attitudes and practices correspond with each other.

This research was supported by a grant from the National Institutes of Health (Dr. Sharon Manne, Principal Investigator). Other authors on the publication include Dr. Deborah Kashy from Michigan State University; Dr. Sherry Pagoto from the University of Connecticut; Dr. Susan Peterson from the University of Texas MD Anderson Cancer Center; Dr. Carolyn Heckman, Joseph Gallo, Dr. Adam Berger, Alexandria Kulik, Sara Frederick, and Morgan Pesanelli from the Rutgers Cancer Institute of New Jersey; and Dr. David Buller from Klein Buendel.

Collaborator Spotlight:
Dr. Susan Loeb

Collaborator Spotlight:
Dr. Susan Loeb

Susan J. Loeb, PhD, RN, FGSA, FAAN, is a Professor in the College of Nursing and the College of Medicine at Penn State University. She earned her nursing degrees at Penn State in 1988, 1992 and 2002. She has also received numerous honors and awards, including being a Fellow of the American Academy of Nursing since 2012.

Dr. Loeb’s signature program of research focuses on addressing the health needs of older incarcerated people with chronic conditions, including those in the advanced stages of disease, and extending through their end of life (EOL). Her expertise in multiple methodological approaches is applied to a series of studies including research, development, dissemination, and implementation of a toolkit for training prison staff in strategies to enhance geriatric and EOL care in prisons. This toolkit has more recently been transformed into computer-based training modules, referred to as “Enhancing Care of the Aged and Dying in Prisons.”

She is currently a Multiple Principal Investigator with Dr. Barbara Walkosz, Klein Buendel Senior Scientist, on a study funded by the National Institute on Aging where their team is conducting research and development on a highly interactive and media-rich set of prototype modules based on best practices in peer caregiving in correctional settings. This training is referred to as “Just Care.”

Dr. Loeb and Dr. Walkosz plan to expand their research collaboration into another age-related disease area: Alzheimer’s Disease and related dementias. They hope to transform best practices in Alzheimer’s Disease and related dementias care into media-rich, highly interactive, computer-based educational modules to prepare corrections staff and peer caregivers to meet the growing care needs of people who are incarcerated and living with cognitive decline.

Dr. Loeb’s research has been disseminated through more than 50 peer-reviewed journal articles and numerous conference presentations. She has served as Principal Investigator or Multiple Principal Investigator on five studies funded by the National Institutes of Health and as Co-Investigator on two additional NIH-funded studies.

Mutual Influences of Mothers’ and Daughters’ Mental Health on the Closeness of their Relationship

Mutual Influences of Mothers’ and Daughters’ Mental Health on the Closeness of their Relationship

A Health Chat study published in the Journal of Child and Family Studies examined intra- and interpersonal associations between poor mental health and mother–daughter relationship closeness in a sample of 467 dyads. Health Chat was a social media intervention designed to reduce mothers’ permissiveness toward their teen daughters’ indoor tanning behavior. It also addressed other adolescent health topics, such as vaccination, alcohol, and physical activity.

An Actor–Partner Interdependence Model was used to examine bidirectional processes between mothers and their teenage daughters. The independent variable was self-reported poor mental health and the dependent variable was relationship closeness. Communication satisfaction was also examined as a potential interpersonal mediator of the pathway between poor mental health and relationship closeness.

Daughters’ self-reported poor mental health negatively predicted their own perception of closeness as well as mothers’ perception of closeness. In addition, there was evidence that perceived communication may help explain both the actor effect (one’s own poor mental health on one’s own perception of closeness) and the partner effect (partner’s poor mental health on one’s own perception of closeness).

Detailed methods and results are presented in the publication. Results suggest that when daughters’ mental health is poor, relationship closeness as perceived by mother and daughter may be weakened, and that this effect may in part be explained by poor communication between mother and daughter. The authors concluded that strategies to promote family communication, especially for families experiencing mental health problems, may aid in the development of closer mother–daughter relationships.

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

Keeping Research Moving During a Pandemic

Keeping Research Moving During a Pandemic

Dr. Susan Loeb, PhD, RN, FGSA, FAAN, from the Pennsylvania State University Ross and Carol Nese College of Nursing – and an active Klein Buendel research collaborator – reflected on her research team’s experience in keeping research productive during the COVID-19 pandemic at the 17th Annual Custody & Caring Conference, November 4-5, 2021. The virtual conference was sponsored by the University of Saskatchewan in Saskatoon, Saskatchewan, Canada. 

The cessation of face-to-face human subjects research by Universities and Departments of Corrections due to the COVID-19 pandemic has challenged researchers to seek alternative approaches for moving their work forward, albeit often not as originally conceived. Dr. Loeb’s presentation, and an accompanying award-winning poster led by Dr. Erin Kitt-Lewis from the Penn State Ross and Carol Nese College of Nursing, reported experiences from the Inmates Care Project,an STTR grant awarded to Klein Buendel by the National Institute on Aging (AG057239; Dr. Susan Loeb and Dr. Barbara Walkosz, Multiple Principal Investigators).

The Inmates Care study served as an exemplar to demonstrate strategies and adaptions employed to forge ahead in modified yet meaningful ways despite a protracted public health emergency. Inmates Care focuses on the research and development of computer-based training to prepare incarcerated persons to assist corrections staff in caring for people who have grown old behind bars and are approaching the end of their lives in prison. Identification of barriers and facilitators, re-envisioning how the team would restructure their day-to-day work, and preparing for the future were a few of the essential steps that were described.  

Key Lessons Learned

  • Seizing the opportunity to make investments in team member development;
  • Writing protocols that detail both in-person and virtual options for data collection to allow the team to pivot quickly when the next challenge arises; and
  • Reaching out to brainstorm with funding agency program officers, Institutional Review Board analysts, advisory board members, and other researchers beyond the team.

Such initiatives can result in scientifically sound, safe, and pragmatic solutions to keep research productive despite public health challenges. Taken together, these approaches can maintain study progress and scientific integrity, as well as identify alternate ways to achieve study aims in a timeline necessarily relaxed, but as close as possible to the original plan.

Co-authors on the presentation and 1st Place poster included Dr. Erin Kitt-Lewis, Sherif Olanrewaju, and Leigh Casey from Penn State University; Dr. Valerie Myers formerly from Klein Buendel; Jeannyfer Reither and Savanna Olivas from Klein Buendel; and Katherine Aiken from the Penn State College of Health and Human Development.

In addition to the paper and poster presentation, Dr. Loeb was also an invited panelist on a Closing Keynote titled, “Reflections on Forensic Mental Health and Correctional Nursing.”

Let’s Talk About Skin Cancer

Let’s Talk About Skin Cancer

Family communication about skin cancer risk may motivate people to put sun protection into practice. However, the availability, distribution, and reach of such communication is not well known.

In a recent publication in the Journal of Health Communication, authors including Dr. David Buller from Klein Buendel, describe prevalence and patterns of family communication about skin cancer across 600 diverse primary care patients. The patients were from Albuquerque, New Mexico, a geographical location with low latitude and significant year-round ultraviolet radiation from the sun.

Over half of the patients reported discussing general cancer and skin cancer risks with their families. The most frequent target of skin cancer risk communication included doctors, followed by friends/coworkers, spouse/partner, other family members, sisters, mothers, daughters, sons, fathers, and brothers. On average, participants reported having talked to three family members about skin cancer risks.

The most frequently discussed skin cancer risk communication topics were the use of sun protection, followed by the personal risk of skin cancer, who had skin cancer in the family, family risk of skin cancer, time of sun exposure, and skin cancer screening. Overall, greater family communication about general cancer and skin cancer risks was associated with a family or personal history of cancer, higher perceived risk, higher health literacy, being non-Hispanic, having higher education or income, and proactive sun protective behavior.

These study findings have implications for developing interventions that encourage family discussions about skin cancer risk, sun protection, and skin cancer screening that may foster the adoption of sun-protective behaviors and reduced exposure to harmful ultraviolet radiation.

This research was supported by a grant from the National Cancer Institute (CA181241; Dr. Jennifer Hay and Dr. Marianne Berwick, Multiple Principal Investigators). Authors in addition to the Principal Investigators include Dr. Smita Banerjee (lead author) and Dr. Elizabeth Schofield from the Memorial Sloan Kettering Cancer Center; Dr. Andrew Sussman, Dr. Dolores Guest, Dr. Yvonne Dailey, Dr. Matthew Schwartz, and Dr. Keith Hunley from the University of New Mexico; Dr. Kimberly Kaphingst from the University of Utah; and Dr. David Buller from Klein Buendel.

STAC-T: Formative Research Results

STAC-T: Formative Research Results

Formative research, such as target population focus groups and usability testing, is essential for the design and development of interactive technology-based programs. Usability testing results of a brief web-based middle school bystander bullying prevention program, STAC-T, were published recently in JMIR Formative Research. The research team was led by Dr. Aida Midgett from Boise State University. Key collaborators included Dr. Diana Doumas from Boise State University and Dr. Valerie Myers, formerly from Klein Buendel.

STAC-T translates four strategies to train bystanders to effectively intervene to reduce bullying into a time- and cost-effective web-based program for middle school students and staff. The four strategies are: “Stealing the show,” “Turning it over,” “Accompanying others,” and “Coaching compassion.”

The main purpose of the formative research was to assess the usability and acceptability of a STAC-T prototype in advance of full-scale development. Other aims included understanding school needs and barriers to program implementation, and assessing differences in usability between middle school staff and students. 

Sixteen participants from three middle schools in rural, low-income communities completed STAC-T usability testing and a qualitative interview. The publication describes the usability testing methods and outcomes of data analyses, including ratings of prototype program satisfaction, acceptability, feasibility, needs, barriers, and recommendations for program adjustments. Overall, school staff and students reported satisfaction with the web-based program. They found it easy to use, acceptable, and feasible. The findings have encouraged the authors to pursue the full-scale development of the STAC-T web-based bullying prevention app for middle schools.

The STAC-T feasibility project was funded by a small business STTR grant to Klein Buendel from the National Institute on Minority Health and Health Disparities at the National Institutes of Health (MD014943; Dr. Aida Midgett, Principal Investigator). The STAC-T prototype was programmed by Klein Buendel’s Creative Team.



African American men experience significant health disparities across a number of preventable chronic diseases including cardiovascular disease, strokes, diabetes, and cancer. Physical activity (PA) is a modifiable risk factor for these conditions. However, the limited number of clinic- or community-based PA promotion studies that have included African American men have resulted in successful short-term behavior change for PA levels. Maintenance of increased PA levels over an extended time period is needed for sustained health benefits.

A research team from Klein Buendel, the Pennington Biomedical Research Center (PBRC), and Georgetown University are launching a new research project to address PA maintenance in African American men with technology. The project is: A Smartphone App to Increase and Maintain Physical Activity in African American Men (FitBrothers). The effort is being led by Dr. Robert Newton from PBRC and is being funded by a Fast-Track STTR grant to Klein Buendel from the National Institute of Minority Health and Health Disparities (MD014947; Dr. Robert Newton, Principal Investigator).

Dr. Newton’s preliminary focus group data indicates that African American men would be receptive to maintenance strategies delivered via smartphone. For this new project, the team will develop a prototype smartphone app and conduct usability testing to determine design viability and acceptability among would-be users in Phase I. In Phase II, the team will conduct a comparative effectiveness trial to assess success of the app on the PA maintenance levels of participating African American men.

Dr. Newton is an Associate Professor of Physical Activity and Ethnic Minority Health at PBRC. His research collaborators include Dr. Derek Griffith from Georgetown University and Dr. David Buller from Klein Buendel. Dr. Griffith is the Founding Co-Director of the Racial Justice Institute, Founder and Director of the Center for Men’s Health Equity, and Professor of Health Systems Administration and Oncology at Georgetown. Dr. Buller is the Director of Research at Klein Buendel. The FitBrothers app will be engineered by Klein Buendel’s Creative Team.

Mothers and Teenage Daughters: HPV Vaccination Information via Social Media

Mothers and Teenage Daughters: HPV Vaccination Information via Social Media

Dr. David Buller, Klein Buendel’s Director of Research, and his coauthors have published results from the Health Chat Project in the online journal, Frontiers in Digital Health. Health Chat was designed as a social media intervention to reduce mothers’ permissiveness toward their teen daughters’ indoor tanning behavior. It also addressed other adolescent health topics, including human papillomavirus vaccination.

“Parents acquire information about human papillomavirus (HPV) vaccines online and encounter vaccine-critical content, especially on social media, which may depress vaccine uptake,” according to the authors. To help address vaccine hesitancy and misinformation, the authors employed a Facebook-delivered adolescent health campaign targeting mothers with posts on HPV vaccination. The study examined the relationship between mothers’ comments and reactions to posts about HPV and any change in their self-reports of having their daughters vaccinated.

The online publication describes the study’s hypotheses, social media health intervention, research methods, results, communication strategies, and limitations. The behavioral research was guided by social cognitive theory, transportation theory, and diffusion of innovations theory. In summary, mothers commented both positively and negatively toward HPV vaccine-related posts. Also, vaccinations rates increased from baseline, through 12-month and 18-month follow-up assessments.

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