Collaborator Spotlight:
Dr. Anne Ray

Collaborator Spotlight:
Dr. Anne Ray

Anne Ray, Ph.D., is an Assistant Professor at the University of Kentucky College of Public Health in the Department of Health, Behavior & Society. She earned a B.S. in Psychology from Penn State University in 2004, an M.Ed. in Counselor Education from Penn State in 2010, and a Ph.D. in Biobehavioral Health from Penn State in 2011.

Dr. Ray’s areas of research interest include etiology and prevention of substance use in adolescence and emerging adulthood; self-regulated drinking behaviors and their associations with alcohol use and consequences; gender differences in alcohol use behaviors; mechanisms of change and moderators of program efficacy; and event-specific measurement of health behaviors.

Klein Buendel and Dr. Ray are currently collaborating on two intervention-based research projects. The first intervention is called Parenting Now. It aims to provide an efficient, engaging, and effective means to enhance parents’ ability to reduce prevalence of substance use and its consequences through a digital curriculum for parents of high-school-aged adolescents. Parenting Now is a brief, interactive, self-paced, and digital curriculum for parents of high-school-aged adolescents created from the evidence-based Parent Handbook, available in hard copy and DVD for college-bound youth only. The curriculum is needed because most parent-based prevention interventions target children or young adolescents, neglecting older adolescents, despite that fact that alcohol use increases in frequency and risk through mid-adolescence. This research project is led by Dr. Michael Hecht from Real Prevention and is funded by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (AA025293).

The second intervention is a new research project designed to curb drinking and risky sexual behavior by first-year college students. The new study will assess the impact of a brief, personalized intervention utilizing an innovative, cross-tailored, dynamic feedback component. The intervention will purposefully integrate content on the relationship between alcohol use and risky sexual behavior. It will leverage technology to incorporate daily assessments of student behavior and deliver weekly dynamic feedback to help reduce risky behavior. This research project is led by Dr. Ray and is funded by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (AA028246)

Results of a Social Media Campaign to Prevent Indoor Tanning by Teens: A Randomized Controlled Trial

Results of a Social Media Campaign to Prevent Indoor Tanning by Teens: A Randomized Controlled Trial

Indoor tanning (IT) increases the risk of developing melanoma. A social media campaign to reduce mother’s permissiveness toward their teenage daughters’ IT was designed and evaluated by Dr. David Buller, Director of Research at Klein Buendel, and his research team. He gave a presentation on the campaign at the virtual 71st Annual International Communication Association Conference, May 27-31, 2021.  

A total of 869 mothers of teenage daughters aged 14-17 in 34 states without bans on IT by minors were enrolled in a randomized controlled trial with two assessments, baseline and 12-month follow-up in 2017-19. A year-long adolescent health campaign was delivered to all participants. The intervention group received posts on preventing IT while the control group received posts about preventing prescription drug misuse. Mothers completed assessments of permissiveness for daughters to indoor tan, self-efficacy for refusing permission, communication with daughters about avoiding IT, attitudes and intentions toward IT, IT behavior, and support for state IT bans. Daughters (n=469; 54%) completed the assessments at baseline and at 12 months.  

At the 12-month follow-up, intervention-group mothers were less permissive of IT by daughters, reported more communication with daughters about avoiding IT, and had lower intentions to indoor tan than control-group mothers. Daughters confirmed intervention-group mothers communicated about IT and shared IT posts more than control-group mothers.  

Overall, a social media campaign may be an effective strategy to convince mothers to withhold permission for IT, which may help increase the effectiveness of state laws designed to reduce IT by minors by requiring parental permission.  

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

Responding to COVID-19 Misinformation in a Social Media Feed

Responding to COVID-19 Misinformation in a Social Media Feed

Social media play a large role in disseminating news on COVID-19 but they also have spread misinformation. Strategies have been suggested for correcting misinformation from fact-checking to digital and media literacy. Dr. David Buller, Director of Research at Klein Buendel, is studying an approach to responding to misinformation in a social media feed on COVID-19 and the reactions of participants to responses. He gave a presentation on the research at the University of Connecticut’s virtual mHealth Conference, May 13-14, 2021.

A total of 303 mothers with adolescent daughters who had previously participated in a social media campaign on indoor tanning were recruited in January 2021 and enrolled in a single-factor design comparing information sources in a 9-week Facebook feed (government agencies v. near-peer parents v. news media) with four assessments (baseline, 3 weeks, 6 weeks, and 9 weeks). The social media feed addressed non-pharmaceutical interventions such as social distancing, COVID-19 vaccination, digital and media literacy skills, and family communication about COVID-19. A community manager scheduled posts (5 per week), monitored reactions and comments, and responded to mothers’ comments that conveyed misinformation within 24 hours following a pre-established protocol. Misinformed comments were defined as being in opposition to recommendations of scientific authorities.

Of the 135 posts total (45 per group), 13% received comments containing misinformation (54 comments) and the community manager responded to 48 of the misinformed comments. Mothers posted the most misinformation in the near-peer parent group (27 comments); those in government agency group (17 comments) and news media groups (10 comments) posted less misinformation. Most comments with misinformation were in response to vaccination posts. The community manager’s responses to misinformation acknowledged mothers’ comments and then stated facts (such as efficacy and safety of vaccines) and cited evidence-based sources (such as the CDC) to refute the misinformation. The community manager also validated mothers’ concerns and confusion, if expressed in these posts, and occasionally stated personal experience or asked a follow-up question to promote dialogue. After responses were posted, ten original posters commented again and three reacted to the reply with “like/love”. Also, at times, other moms commented, reacted, or sent a private direct message related to response to misinformation.

Feeds on COVID-19 vaccines and non-pharmaceutical interventions can attract misinformation from individuals following them. Response strategies did not appear to generate a debate with mothers who posted misinformation, possibly because it conveyed an understanding of their positions or acknowledged their uncertainty or confusion rather than confronted them. Responses seemed to garner some supportive reactions from other mothers for the community manager, perhaps because the response made them feel supported to express their disagreement with the misinformation. These reactions could serve to reinforce the correction of misinformation for other followers of the social media feed.

This research is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller, Principal Investigator). Collaborating authors include Dr. Sherry Pagoto and Joseph Divito from the University of Connecticut; and Dr. Barbara Walkosz, Dr. Gill Woodall, Julia Berteletti, and Alishia Kinsey from Klein Buendel.

Engagement with a Social Media Campaign for Mothers to Reduce Permissiveness for Daughters’ Indoor Tanning

Engagement with a Social Media Campaign for Mothers to Reduce Permissiveness for Daughters’ Indoor Tanning

Indoor tanning (IT) by adolescents increases lifetime risk of developing melanoma. Dr. David Buller, Director of Research at Klein Buendel, is leading an examination of a social media campaign for mothers to reduce their permissiveness toward indoor tanning by their teenage daughters. Dr. Buller presented findings on mothers’ engagement with the social media campaign – Health Chat – at the D.C. Health Communication (Virtual) Conference, April 23-24, 2021.

Several states require parents to consent or accompany minor children using IT facilities. Engagement of mothers with the social media campaign was examined to see if it modified campaign effects on mothers’ permissiveness for their teen daughters to indoor tan. Mothers (N=869) with daughters aged 14-17 were recruited in 34 states that do not ban IT by minors under 18 for a randomized trial with follow-ups at 12-month and 18-month post-randomization.

Mothers received an adolescent health social media campaign in Facebook private groups. Half of mothers were in a group in which the campaign included posts about preventing IT (intervention) and the other half, included posts on preventing prescription drug misuse (control). Engagement was measured by extracting reactions (e.g., like, sad, etc.) and comments posted by mothers to the campaign posts addressing IT or prescription drug misuse. Follow-up surveys assessed mothers’ permissiveness for daughters to indoor tan, i.e., whether mothers would permit daughters to indoor tan or facilitate them doing so (e.g., take them to a tanning facility). Daughters (n=469; 54.0%) were invited to complete baseline and follow-up assessments.

Mothers were mostly non-Hispanic white, college educated, and had household incomes exceeding $80,000. Nearly one-third had a family history of skin cancer and just over one quarter had high-risk skin types. At 12-month and 18-month follow-up, engagement with the social media campaign moderated the impact of treatment group on mothers’ permitting and facilitating IT by daughters. Specifically, among mothers who engaged with the campaign, mothers in the intervention group had lower permissiveness for IT and less facilitation of IT by their daughters than in the control group. These differences did not occur between treatment groups among mothers with no engagement in either permissiveness or facilitation at either follow-up.

Social media campaigns may be used to improve IT public policies by decreasing mothers’ permissiveness and increasing communication with daughters about avoiding IT. However, social media messages need to reach and engage mothers to be effective, in this case on convincing mothers to not permit or facilitate daughters’ request to indoor tan. Prevention messages, when interspersed in a social media feed on adolescent health, may reduce IT by female adolescents by improving compliance with public policies restricting minor access to IT facilities.

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

Online Responsible Vendor Training in Recreational Marijuana Stores

Online Responsible Vendor Training in Recreational Marijuana Stores

A collaborative research team with scientists and staff from Klein Buendel, the Prevention Research Center in Berkeley, California, and the University of Alabama, Birmingham recently published the results from a randomized trial testing an online responsible vendor training program in recreational marijuana stores in the United States. The team was led by Dr. David Buller, Director of Research, and the results were published in the Journal of Studies on Alcohol and Drugs (JSAD).

The responsible marijuana vendor (RMV) training program implemented in the study was Train To Tend®. Train To Tend is an interactive, media-rich, online, comprehensive RMV program created by Klein Buendel. It’s five modules address state laws and regulations, preventing sales to minors, health effects of marijuana, customer service, and rules of the trade. Train To Tend provides state-approved instruction and certification of cannabis sellers. 

In the JSAD publication, the authors detail the measures, methods, analyses, and results of the randomized trial to evaluate the impact of the RMV training program on refusing sales to buyers without proper identification. The trial was conducted with 175 recreational marijuana stores in Colorado and Washington State using a pseudo-underage patron procedure. The results showed that online RMV training could increase sellers’ refusal of potential buyers at entrance to the store who looked youthful and did not provide state-approved identification.

As more states legalize recreational marijuana sales, responsible vendor training in the safe sale of cannabis products can become more essential to helping to ensure youth and community safety.

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). Co-authors on the publication include Dr. Robert Saltz from the Prevention Research Center in California; Dr. Gary Cutter from the University of Alabama, Birmingham; and Dr. W. Gill Woodall, Andrew Grayson, Mary Klein Buller, Sierra Svendsen, and Xia (Lucia) Liu from Klein Buendel.

Long-term Effects of a Social Media Campaign for Mothers to Prevent Indoor Tanning by Teens in a Randomized Trial

Long-term Effects of a Social Media Campaign for Mothers to Prevent Indoor Tanning by Teens in a Randomized Trial

Indoor tanning (IT) increases risk of developing melanoma, yet IT remains popular with some teen girls. Mothers can influence IT initiation. Dr. David Buller, Director of Research at Klein Buendel, presented long-term effects of a social media intervention for indoor tanning at the 42nd Annual (Virtual) Meeting & Scientific Sessions of the Society of Behavioral Medicine, April 12-16, 2021.

Several states require parents to consent or accompany minor children using IT facilities. Health Chat, a social media campaign was tested that aimed to reduce mothers’ permissiveness for their teen daughters to indoor tan, decrease mothers’ and daughters’ IT behavior, and increase mothers’ support for bans on IT by minors. A sample of mothers (n=869) with daughters aged 14-17 in 34 states without bans on IT by minors were enrolled in a 12-month randomized trial.

All mothers received a campaign on adolescent health in Facebook private groups containing posts on a variety of health topics (for example, substance abuse or mental health) and mother-daughter communication. In the intervention group, the campaign included posts about preventing IT, whereas in the control group, it included posts about preventing prescription drug misuse. Long-term effects were assessed by comparing mothers’ responses at baseline to responses at 18-months post-randomization. Measures assessed permissiveness for daughters to indoor tan, self-efficacy for refusing permission for IT, communication with daughters about avoiding IT, attitudes and intentions toward IT, IT behavior, and support for state bans on IT by minors. The daughters (n=469) only completed baseline and follow-up assessments.

At the 18-month follow-up, intervention-group mothers were less permissive of IT by daughters, reported more communication with daughters about avoiding IT, had greater self-efficacy to refuse daughter’s request for IT, expressed less positive attitudes toward IT, had lower intentions to indoor tan, and were more supportive of bans on IT by minors under age 18 than control-group mothers. At 18-months, daughters in the intervention group had less positive attitudes toward IT than in the control group.

Social media may be an effective channel to convince mothers to withhold permission for IT by daughters and thus reduce IT by minors in states requiring parental permission provided IT facility operators request this permission. Increased support among mothers for bans on IT might facilitate efforts to place more restrictions on IT.

This research project is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller, Principal Investigator). Collaborators on the conference presentation include Dr. Sherry Pagoto and Jessica Bibeau from the University of Connecticut; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kimberly Henry from Colorado State University; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.

Experiences from the Health Chat Intervention

Experiences from the Health Chat Intervention

Dr. David Buller, Director of Research at Klein Buendel, presented experiences from the Health Chat Intervention during a symposium at the 42nd Annual (Virtual) Meeting & Scientific Sessions of the Society of Behavioral Medicine, April 12-16, 2021. Health Chat is a social media intervention for mothers and their teenage daughters designed to influence their decisions related to indoor tanning.

Despite declines in recent years, indoor tanning (IT) remains popular with some adolescent females. IT initiation can be influenced by mothers’ permissiveness toward IT and IT behavior. Social media is a popular channel with mothers for adolescent health information. Our research team developed a series of social media posts to prevent IT and evaluated their impact on mothers’ permissiveness, mothers’ and daughters’ IT attitudes, intentions, and behavior, and mothers’ support for bans on IT by minors. Investigators used an iterative method to develop theory-based social media posts, based on diffusion of innovations theory, social cognitive theory, and transportation theory of narratives.

Two innovative research techniques were employed. First, to stimulate engagement with the IT messaging, posts were embedded in a larger social media campaign on adolescent health (for example, substance abuse, diet and physical activity, and mental wellness), with 2-3 posts on IT (about 113 posts total) among the 14 health posts per week (about 710 posts total). Frequency and currency of IT posts were adjusted to avoid message fatigue and disengagement. Second, the campaign was delivered to in two Facebook private groups to create experimental separation, with control-group mother receiving posts on preventing prescription drug misuse. Recruitment was challenging with initial community-based techniques (such as schools, community groups/events, and out-calls) being largely unsuccessful.

The sample of mothers (n=869) was ultimately obtained from the Qualtrics Internet Panel from 34 states without bans IT by minors. They completed assessments at baseline and 12- and 18-months post randomization. Daughters were invited to complete baseline and follow-up assessments but just over half did so at baseline. Most mothers (87%) stayed in the private groups for the entire 12-month campaign and 277 mothers engaged with the IT posts. The effects of the IT posts in 12- and 18-months follow-ups were most evident in mothers’ reduced permissiveness and increased communication with daughters about the harms of IT. It also reduced mothers’ intentions to indoor tan. At the long-term follow-up, the campaign increased mothers’ support for bans on IT by minors and self-efficacy to refuse IT request from daughters. While there was no direct effect on mothers’ or daughters’ IT behavior, these changes may serve to prevent daughters from engaging in IT in the future. They also could help to support public policy efforts to curb further IT by minors.

This research project is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller, Principal Investigator).

Listen to the Health Chat presentation:

Baseline Survey of Managers on Occupational Sun Protection in a Randomized Trial of Scale-up

Baseline Survey of Managers on Occupational Sun Protection in a Randomized Trial of Scale-up

Scale-up is the effort to increase the impact of successful prevention interventions to benefit more people on a lasting basis. Successful and affordable methods for scaling-up evidence-based programs are needed to prevent skin cancer among adults, particularly those who work outdoors in the sun.

Dr. David Buller, Director of Research at Klein Buendel, presented baseline findings from the scale-up of an occupational skin cancer prevention program at the 42nd Annual (Virtual) Meeting & Scientific Sessions of the Society of Behavioral Medicine, April 12-16, 2021.

A randomized trial is being conducted to compare two methods of scaling up, nationwide, an effective occupational sun protection intervention, Sun Safe Workplaces, that promotes policy and education for outdoor workers. Departments of Transportation (DOTs) from 21 U.S. states are participating and their 138 regional districts were randomized following baseline assessment. The state DOTs range in size from 997 to 18,415 employees. At baseline, 1,113 managers (49.0%) completed the pretest. Managers were generally supportive of occupational sun safety policy, but also felt employees should take action on their own on sun protection. A minority reported that their DOT had a written policy or standard operating procedure on occupational sun protection. Just over half reported that the DOT provided training on sun safety to employees and/or managers and supervisors. About two-thirds reported that the DOT provided messaging on sun protection and sun protection resources, such as sunscreen, clothing, hats, or eyewear. Other sun safety actions were less commonly reported (for example, provision of shade, UV Index monitored and outdoor work activities adjusted, or employees encouraged to regularly check skin for signs of skin cancer.

Occupational sun exposure receives some attention at DOTs, mainly in the form of training and provision of sun safety resources. However, it appears that several employees may not be practicing sun protection because of lack of policy and/or sun safety prevention efforts. Policy on occupational sun safety is less common, despite the link of solar UV to skin cancer. Health promotion approaches that incorporate policy with education might help to improve implementation of sun safety at the workplace.

This research project (CA210259; Dr. David Buller, Principal Investigator) is funded as part of the National Cancer Institute’s Cancer Moonshot Initiative, which aims to accelerate cancer research in order to make more therapies available to patients, while also improving the ability to prevent cancer and detect it at an early stage. Collaborators on the conference presentation include Dr. Richard Meenan from Kaiser Permanente’s Center for Health Research, Dr. Gary Cutter from Pythagoras, Inc., Dr. Sherry Pagoto from the University of Connecticut, and Ms. Mary Buller, Ms. Julia Berteletti, Ms. Rachel Eye, and Dr. Barbara Walkosz from Klein Buendel. This baseline data is published in Contemporary Clinical Trails.

Listen to the Research Spotlight presentation.

Translation of an In-Person Bystander Bullying Intervention to a Technology-Based Platform

Translation of an In-Person Bystander Bullying Intervention to a Technology-Based Platform

Klein Buendel Senior Scientist, Dr. Valerie Myers, and collaborators from Boise State University will be presenting a poster showcasing the development of a technology-based bullying prevention program during the 42nd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine from April 12-16, 2021.

Bullying is a significant problem in the United States, with more than a quarter of middle school students reporting bullying victimization. Bullying is associated with multiple mental health, social, and academic consequences. Although comprehensive school-wide interventions are available, they require significant resources for implementation, reducing access to schools, particularly in rural or low-income communities. Thus, there is a need for bullying programs that effectively address bullying while removing implementation barriers.

The STAC intervention is a brief, bystander bullying intervention that includes psychoeducation and role-plays to increase knowledge and skills to intervene in bullying. STAC stands for four strategies students can use when they witness bullying: “Stealing the show,” “Turning it over,” “Accompanying others,” and “Coaching compassion.” A series of randomized controlled trials have demonstrated the efficacy of the STAC intervention in reducing bullying perpetration and victimization, as well as depression, anxiety, and alcohol use.

The goal of the project presented in the poster was to translate the STAC program into a technology-based platform (STAC-T) for middle schools. The aims of this study were to: (1) conduct a needs assessment with middle school personnel, (2) develop a web-based prototype based on the in-person STAC intervention through iterative focus groups, and (3) conduct usability testing with middle school students and school personnel. Qualitative data from the needs assessment indicated a strong interest in a technology-based bullying intervention and positive conditions for implementation including administrative support and school technology-readiness. Students who participated in iterative focus groups reported the app concept was easily understood and engaging and identified essential features for a successful prototype.

Results from usability testing indicated participants perceived the STAC-T program to be useful and appropriate for their school and community. Findings from this study showed that the STAC-T program is relevant and feasible for implementation in the middle school settings and is usable for the target audience.

The STAC-T project is funded by an 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). A third collaborator, in addition to Dr. Midgett and Dr. Myers, is Dr. Diana Doumas from Boise State University.

Using Project Management Skills in Behavioral Research

Using Project Management Skills in Behavioral Research

Research projects have various moving parts throughout their lifespan needing to be completed within a certain timeframe and budget as outlined in the grant awarded. Project management skills are crucial in ensuring all phases, tasks, and logistics of a research project are organized and completed within deadline and scope.

The workload of a project is driven by how each aim breaks down into a phase, each with its own specific deliverables to be fulfilled and unique timeline to be met. As each phase of a project moves forward, the responsibilities are often compounded due to overlapping timelines, creating an increased need to think ahead and utilize efficient multi-tasking and organizational skills.

Research Project Management Phases

  • Determining and communicating the scope derived from the grant aims and methods;
  • Developing timelines;
  • Protocol development (such as recruitment, screening, data entry, intervention, data management, and adverse event processing);
  • Obtaining necessary institutional approvals;
  • Staff identification/hiring, training, and evaluation;
  • Goal setting including incremental goals as well as larger overarching goals;
  • Project implementation;
  • Delivering objectives including communication of progress toward objectives;
  • Tracking budgeted and expended costs;
  • Required reporting to aid in communicating progress; and
  • Problem-solving as issues inevitably arise.

Communication is a key component to ensuring a smooth flow of the deliverables throughout the project. All personnel on a project need to maintain the same vision and goals. This can often be accomplished using regular meetings, phone calls, emails, and reports. Beyond the regular means of communication, a more comprehensive system such as project management software can be used to keep track of deliverables and deadlines.

Klein Buendel Research Program Manager, Julia Berteletti, organized and participated in a research project management Pre-Conference Workshop at the virtual 42nd Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM), April 12-16, 2021. Her co-presenter was Jessica Bibeau from the University of Connecticut. The presenters have been coordinating multi-site research projects from coast-to-coast with each other for several years. Ms. Berteletti explained, “Our projects run on effective partnerships. Facilitating teamwork is one of my favorite parts of my job. It meant a lot to me for us to share our methods for effective collaboration and project management with other research teams.” The SBM seminar provided a guide for managing a research project using a project management approach which included: (a) understanding the scope, (b) setting goals, (c) considering the costs, (d) implementation (intervention/data collection), and (e) close-out. A hypothetical project was used to present each part of the approach. Team organization, communication, important considerations, timelines, charts, and reports were reviewed to aid in organization, and project management software ideas were provided along with a tutorial of the Basecamp software.