INSIGHTS ON HPV VACCINATION FROM MOTHERS’ COMMENTS ON FACEBOOK POSTS IN A RANDOMIZED TRIAL

INSIGHTS ON HPV VACCINATION FROM MOTHERS’ COMMENTS ON FACEBOOK POSTS IN A RANDOMIZED TRIAL

HPV vaccine uptake among adolescent girls in the United States remains below the national goal of 80%. Parent decisions to vaccinate daughters can be impeded by confusion, uncertainty, and misinformation about the Human Papilloma Virus (HPV) vaccine. Dr. David Buller from Klein Buendel (KB) presented an analysis of mothers’ beliefs about vaccinating their adolescent daughters for HPV at the Eurogin International Multidisciplinary HPV Congress in Lisbon, Portugal, December 2-5, 2018.

Mothers with adolescent daughters from 34 states (n=880) were recruited to participate in a randomized controlled trial evaluating a social media campaign on adolescent health. The mothers’ beliefs were expressed in comments to posts on HPV vaccination in a social media campaign on adolescent health. Participants were recruited through Qualtrics survey panels or local efforts at the Tennessee study site. Eligibility criteria were: having a daughter aged 14-17, living in one of 34 states without a complete ban on indoor tanning for minors, using a Facebook account 1+ times a week, being able to read English, consenting to participate, completing the baseline survey, and willing to join the Facebook group. The campaign, implemented through Facebook private groups, included posts on HPV vaccination, as one of seven general health topics. The experimental manipulation varied posts on indoor tanning versus prescription drug abuse prevention. Posts on HPV vaccination and reactions and comments from mothers were extracted.

Mothers had a mean age of 43.1 years; 6.5% were Hispanic and 86.6% white; and 63.1% reported that their daughter had been vaccinated for HPV (17.8% receiving two shots and 31.5% three shots). HPV vaccination posts received on average 1.3 reactions and 3.3 comments from mothers. Comments often formed a dialogue among mothers. More than half of the comments (52.8%) were favorable, indicating that the daughter had been vaccinated and HPV vaccination reduced mothers’ anxiety, HPV infection rates, and related disease risk. However, 45.3% were unfavorable, citing safety concerns, lack of efficacy, unknown long-term consequences, inappropriate age for the vaccine, apprehension by other mothers, fears of vaccine tampering, lack of physician support, and sexual activity issues (for example, plans to wait until daughter becomes sexually active or using vaccine to guard against unprotected sex). Some commented, mostly favorably, on the need to vaccinate boys.

Facebook comments indicated both support for and resistance to HPV vaccination by mothers in the United States. Reasons for not vaccinating girls were similar to barriers expressed in other research and reflected negative media coverage of HPV vaccination. Effective strategies are needed in social media to counter misinformation on and resistance to HPV vaccines.

This research was funded by a grant from the National Cancer Institute (CA192652; Dr. David Buller, Principal Investigator). Collaborators include Dr.Barbara Walkosz and Julia Berteletti from KB; Dr. Sherry Pagoto and Jessica Oleski from the University of Connecticut, and Dr. Katie Baker from East Tennessee State University.

Eurogin is one of the most important conferences in the world on HPV infection and related cancers. The international gathering examines public health, health services, screening, and prevention of HPV-induced cancers.

Developing and Testing E-Training to Enhance Care of Aged and Dying Prisoners

Developing and Testing E-Training to Enhance Care of Aged and Dying Prisoners

Klein Buendel (KB) collaborator, Susan Loeb, PhD, RN, described the development and testing of computer-based training for corrections staff on caring for aged and dying prisoners in a poster she presented at the National Commission on Correctional Health Care (NCCHC). The conference was held in Las Vegas, NV from October 20-24, 2018.

The Enhancing Care of the Aged and Dying in Prisons (ECAD-P) training program is a collaboration between KB and Penn State University. The research team, which includes KB Senior Scientist, Dr. Valerie Myers and KB’s Creative Team, built upon electronic file training materials that had been developed at Penn State University, and transformed them into interactive computer-based training that is relevant to a broad spectrum of correctional staff.

Approaches employed in an earlier phase of this research included: (a) engagement with an Expert Advisory Board, including representatives from corrections, geriatrics, and hospice; (b) a Community Advisory Board constituted by corrections officials and returning citizens; (c) an environmental scan conducted with corrections training officers and information technology staff; (d) a modified Delphi survey with geriatric and corrections nurses; and (e) initial in-person usability testing of an early version of three training modules. In a second phase, usability testing of six modules was conducted in a large jail in the Northeast and a State Correctional Institution in the Midwest.

Analytic approaches employed throughout this research included content analysis, geriatric content identification, and acceptability, feasibility, and usability evaluation using qualitative observation approaches and the System Usability Scale. The Phase I study established proof of concept, produced three prototypical modules, a drafted a detailed specifications document for full program development in Phase II. Phase II included refinement of Phase I learning modules and development of three additional modules. Phase II assessments showed that the program is acceptable, feasible, and usable in corrections.

The NCCHC poster concluded that correctional settings across the United States face growing demands to better address the health care and management needs of aged, chronically ill, and dying inmates. The ECAD-P computer-based training holds promise to contribute to better preparation of correctional staff to effectively care for these populations.

This research was funded by a Small Business Technology Transfer (STTR) grant to KB from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators/coauthors in addition to Dr. Loeb and Dr. Myers include Dr. Erin Kitt-Lewis from the Penn State University College of Nursing.

Results of a Randomized Trial of the Way To Serve Responsible Alcohol Server Training

Results of a Randomized Trial of the Way To Serve Responsible Alcohol Server Training

Alcohol use and misuse is a leading cause of preventable death in the United States. Alcohol servers may help prevent alcohol-impaired car accidents and other harms by discouraging overconsumption by patrons. Responsible beverage service (RBS) training is designed to improve serving behavior, especially by avoiding selling too many drinks to a patron, refusing sales to intoxicated patrons, and properly checking identification to prevent sales to minors. Positive evaluations of RBS programs have been reported, yet online technologies hold promise for improving training quality, fidelity, cost, and uptake.

In a recent publication in the Journal of Studies on Alcohol and Drugs, researchers led by Klein Buendel (KB) Senior Scientist, Dr. W. Gill Woodall, reported the results of a randomized trial of the media-rich, interactive web-based WayToServe® (WTS) RBS training. The study hypothesized that servers who completed the WTS training would refuse alcohol service to apparently-intoxicated patrons at significantly higher rates compared with servers who completed the usual and customary (UC) live training.

In the study, alcohol-serving establishments (such as bars) in New Mexico were randomly assigned to receive WTS training (n=154) or the UC live training (n=155). Establishments were assessed before training, immediately after training, at six months after training, and at one year after training with a pseudo-intoxicated patron protocol (in which buyers were trained to enacting documented behavioral signs of intoxication) to assess premise alcohol service during early to mid-evening hours. The primary outcome variable for the assessment was the proportion of apparently-intoxicated buyers who were refused alcohol service.

Results indicated significantly higher refusal rates for WTS than for UC premises at the immediate (WTS=68% vs. UC=49%) and the one-year post-training assessment points (WTS=68% vs. UC=58%), but not at the six-month post-training assessment (WTS=69% vs. UC=64%). Results also indicated that younger pseudo-patrons were consistently refused more often than older pseudo-patrons. The study concluded that RBS training can be delivered online, broadening the scale of distribution and making it a potentially more cost-effective way to reach alcohol servers with effective and beneficial RBS training.

A full description of the methods, results, and limitations of this study, as well as commentaries by Buvik & Rossow (2018) and Miller (2018), and an author response, can be found in the Journal of Studies on Alcohol and Drugs.

The research was funded by the National Institute on Alcohol Abuse and Alcoholism (AA014982; W. Gill Woodall, Principal Investigator) at the National Institutes of Health. Collaborators/coauthors includeDr. Randall Starling from the University of New Mexico, Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in California, Dr. David Buller from KB, and Dr. Paula Stranghetta from Paula Stanghetta & Associates, Inc. in Ontario, Canada. KB’s Creative Team produced the WayToServe® web-based training. WayToServe® has been licensed to Wedge Communications LLC for commercial sale and distribution.

Results of Train To Tend Presented at APHA

Results of Train To Tend Presented at APHA

To date, ten U.S. states and the District of Columbia (DC) have legalized the use and/or sale of recreational marijuana. Training in responsible sales practices in the alcohol market has reduced sales to minors and, in some cases, intoxicated patrons. Responsible sales practices training could have similar benefits in the recreational marijuana market.

Dr. David Buller, Director of Research at Klein Buendel (KB) presented the results of the implementation and effectiveness trial of Train To Tend at the Annual Meeting and Expo of the American Public Health Association (APHA) in San Diego, California, November 10-14, 2018. APHA’s annual conference is the largest annual gathering of public health professionals with over 12,000 attendees.

Train To Tend is a unique responsible marijuana vending (RMV) training program developed by KB scientists and staff. The online RMV training was developed through input from state regulators, local law enforcement personnel, Colorado Marijuana Enforcement Division’s curriculum standards, interviews with recreational marijuana store personnel (n=15), and usability testing of a prototype training with store personnel (n=19). The RMV training contained five modules: State laws and regulations, ID checking, health effects of cannabis, customer service practices including recognizing intoxicated patrons, and rules of the trade including inventory tracking.

In a randomized controlled trial enrolling state-licensed retail recreational marijuana stores (n=225) in Colorado, Oregon, and Washington State, 125 stores were randomly assigned to receive the RMV training. Trainees completed pre- and post-training surveys evaluating usability and effects of the training. A total of 459 cannabis store employees completed the online training in 55 stores in the three states between June 2017 and February 2018. The training improved trainees’ ability to check IDs, their confidence to use the state’s inventory tracking system, and their ability to recognize intoxicated customers. Most trainees found the training to be user-friendly (78.4%), were satisfied with it (68.8%), and would recommend it to another employee (91.1%).

Overall, online RMV training was acceptable to retail recreational marijuana personnel and appeared to improve responsible sales practices. Training in responsible sales practices has been a successful policy intervention in the alcohol market that should be considered for the recreational marijuana market.

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). APHA presentation collaborators include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in Oakland, California; and Dr. Gill Woodall, Andrew Grayson, Mary Buller, and Sierra Svendsen from KB. Research details and more results of this study have been reported in an e-publication in the Journal of Public Health Management and Practice.

Technology, Social Media and Behavior Change

Technology, Social Media and Behavior Change

Klein Buendel (KB) Senior Scientist, Dr. Valerie Myers, was an invited presenter at The Colorado Cancer Coalition Annual Symposium held November 8-9, 2018 in Lakewood, Colorado. The mission of the Coalition is to eliminate the burden of cancer in Colorado. This year’s symposium, Elevating Personalized Cancer Care in Colorado, shared updates on innovative cancer care in Colorado and provided education and networking opportunities for professionals who work in cancer prevention, control, treatment, and survivorship.

Dr. Myers spoke about Technology, Social Media and Behavior Change in a session on Using Technology and Social Media to Advance Your Mission. She addressed multiple types of mHealth and eHealth technologies and the research behind their use in implementing health behavior change programs. Using her active research project Caminemos Juntas as an example, she was able to showcase how a smartphone app like Caminemos Juntas can be used to help Latina women overcome barriers to physical activity.

Dr. Myers said, “The benefit of technologies and digital health tools is that they have the capacity to be used in the real world with real people. That is their appeal.” She also stressed the importance of the use of digital technologies saying, “People who normally wouldn’t have access to empirically based and theory driven interventions now have access to them, so it really promotes the ability for scale up. I think this is where individual clinical trial-based health and public health come together really well, because you can translate what’s been done in rigorous trials and get it to the people to see if you can move the needle on these health behaviors.”

In addition to its importance, Dr. Myers said that digital health technologies such as mHealth and eHealth are “the way to get interventions in the hands of people that may never have been exposed to this messaging. If it can reach those individuals who have been neglected traditionally by health intervention and also meet people in a place where they feel comfortable and safe and are ready for change, then that excites me.”

KB scientists and staff have been active members of the Colorado Cancer Coalition and its Skin Cancer Task Force for over a decade.

Nightlife Safety Research

Nightlife Safety Research

Dr. Brenda Miller from the Pacific Institute for Research and Evaluation (PIRE) gave a presentation at the 9th Conference and Members’ Meeting of the European Society for Prevention Research (EUSPR) in Lisbon, Portugal, October 24-26, 2018. EUSPR “promotes the development of prevention science, and its application to practice so as to promote human health and well-being through high quality research, evidence based interventions, policies, and practices.” The research presented by Dr. Miller was designed and conducted in collaboration with scientists and staff from Klein Buendel (KB).

The study of nightclub patrons and their social drinking groups, tests an intervention called Nightlife Safety Plans (NSP). NSP is designed to reduce escalation of overuse of alcohol and drugs, physical aggression, and sexual aggression during an evening at the club. NSP relies on social groups that arrive at the club together to identify early signs of problems and to take actions to intercede. The actions are: Outreach, Options, and Out.

Data analyzed in this presentation consisted of 352 groups (961 participants) gathered over 41 Friday and Saturday nights at seven different clubs in the Bay Area of California. Data from online surveys, alcohol breath tests, and biological drug tests (post-test only) were gathered at entrance and exit for pre- and post-test assessments of the intervention effects. Biological measures reveal at least one club patron per group was legally intoxicated (Breath Alcohol Concentration—BAC, >.08%) in 60% of groups and at least one patron was positive for drugs in 50% of the groups. Further, at least one club patron per group experienced physical and/or sexual aggression within 40% of the groups.

Results indicated that experimental groups were significantly more likely to intervene with group members, using a significantly higher number of intervention strategies (Outreach, Options, and Out), to assess situations for physical aggression and sexual harassment, and to respond to friends experiencing sexual harassment. Further, experimental groups used significantly more protective strategies to keep group members safe. Reduced levels of alcohol use and intoxication or impairment (BAC > .05), as assessed by breath tests, were found among the groups in the experimental as compared to the control condition.

In summary, groups provide an opportunity to deliver and implement peer-focused safety strategies to enhance safety during the time spent in the club. The research’s focus on clubs also reaches young adults who are working (two-thirds were not in college), whereas many of these types of interventions are targeted toward college students.

This research was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA022331; Dr. Brenda Miller, Principal Investigator). Collaborators included Veronica Rogers, Dr. Hilary Byrnes, Dr. Mark Johnson, and Dr. Joel Grube from PIRE; and Dr. David Buller and Julia Berteletti from KB.

 

Using Targeted Photographs to Improve Health Messages for Stigmatized Populations

Using Targeted Photographs to Improve Health Messages for Stigmatized Populations

In a recent e-publication in the Journal of Health Communication, Mary Buller, President of Klein Buendel (KB), and her coauthors report results of an evaluation of using Real Health Photos in health communication messaging. Real Health Photos is a unique collection of images of people with diversity of age, gender, race, ethnicity, income level, and health condition. The collection was produced by KB to portray the diversity of health through photography and promote the inclusion of all populations in health promotion materials and media.

Of particular concern is how to reach underserved populations with effective health messages. Underserved groups with particular health needs — including people with disabilities, the elderly, and the overweight or obese — are underrepresented in popular media images and are often stigmatized so that they have to deal with prejudice and ostracization.

This research project tested the prediction that photographs depicting people very similar to the target population of a health message would improve the health communication and increase the  target populations’ intentions to change behavior in a favorable, more healthful direction. The evaluation of using Real Health Photos in health communication messaging was guided by the homophily principle. The homophily principle — that perceived similarities among people produce positive reactions — is a cross-cultural, global phenomenon and is grounded in the power of identification. Specifically, the study tested two hypotheses: (1) whether a health communication message will be more effective (that is, create stronger behavioral intentions to increase physical activity and eat a healthy diet) when incorporating photographs that match the target population than photographs that do not match the population in disability, age, or weight; and (2) whether the effectiveness of photographs that match the population on disability, age, or weight will be mediated by identification with persons in the photographs (that is, matched photographs will increase identification relative to unmatched photographs and increased identification will be associated with greater behavioral intentions).

To test the hypotheses, three nationally-representative samples of adults (n=1,796) who were physically-disabled, elderly, or overweight/obese were selected from a large national survey panel. Participants read an identical message promoting increased moderate to vigorous physical activity and decreased intake of high fat, high sugar, and high carbohydrate foods. Photographs from a commercial stock photograph service versus photographs created for the research project to match the three populations — from Real Health Photos — were included in the messages. Participants responded to assessments of behavioral intentions, outcome and self-efficacy expectations, and identification. Statistical analysis confirmed that Real Health Photos that matched the specific target population increased behavioral intentions mediated by identification in the physically-disabled and overweight/obese samples. Matched visual images improved health message effectiveness by capitalizing on the homophily and identification processes.

The development of Real Health Photos and this research were funded by a Small Business Innovation Research grant from the National Institute of Minority Health and Health Disparities (MD003338; Mary Buller, Principal Investigator). Coauthors include Dr. Peter Andersen from San Diego State University, Dr. Michael Slater from The Ohio State University, Dr. Kim Henry from Colorado State University, Lyndsay Fluharty from Telligen, Inc., and Dr. Erwin Bettinghaus, Xia (Lucia) Liu, Steve Fullmer, and Dr. David Buller from KB.

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

Dr. Gregory Zimet is a Clinical Psychologist and Professor in the Department of Pediatrics at the Indiana University School of Medicine. Since he arrived there in 1993, he has guided an extensive, multi-faceted research program focused on attitudes about, and acceptance of, vaccines for the prevention of sexually-transmitted infections, including the human papillomavirus (HPV) vaccine.

Currently, Dr. Zimet serves as a KB collaborating scientist with Dr. Gill Woodall and Dr. David Buller on a research project entitled “Web App Technology for Boys and Parents: Improving HPV Vaccine Uptake.” Other collaborating investigators include Dr. Alberta Kong and Dr. Randall Starling from the University of New Mexico. The four-year HPV project, funded by a grant from the National Cancer Institute (CA210125; G. Woodall, PI), is designed to produce a mobile web app to accurately inform parents and adolescent boys about the HPV vaccination and address unique concerns about its safety and effectiveness for boys. The mobile web app is being developed for personal computers, smartphones, and tablet computers.

Dr. Zimet’s research also has involved randomized clinical trials designed to evaluate the effects of brief health communication messages on hepatitis B virus and HPV vaccine uptake, and on acceptance of HIV testing. Through his involvement over the past five years in the Adolescent Medicine Trials Network for HIV/AIDS Interventions, Dr. Zimet has expanded his research focus to examine factors related to recruitment of adolescents into biomedical HIV prevention clinical trials. Biomedical trials that may involve the recruitment of adolescents are related to pre-exposure prophylaxis, HIV vaccine, and microbicides. Some of his recent publications address HPV vaccination, microbicide acceptability among adolescents, and attitudes about HIV and herpes simplex virus type 2 testing.

Dr. Zimet has served as a research mentor to five physician fellows, over 20 pre- and post-doctoral fellows in psychology, social work, health behavior, and nursing, and several junior faculty in the Department of Pediatrics and the School of Nursing at Indiana University.

¡Caminemos Juntas!: A Smartphone App for Latinas to Connect with Walking Partners

¡Caminemos Juntas!: A Smartphone App for Latinas to Connect with Walking Partners

Dr. Valerie Myers, Klein Buendel (KB) Senior Scientist, is the Principal Investigator leading a new research project aimed at helping Latinas combat barriers to physical activity using smartphone technology and social networks.

Hispanic women are a growing and influential segment of the population, yet health disparities for Latinas remain high. Latinas are more likely than their non-Hispanic White counterparts to be overweight, diagnosed with diabetes, and physically inactive. Regular physical activity promotes physical and emotional well-being, such as lower risk of heart disease and diabetes, weight management, and improved quality of life, yet physical activity interventions for Latinas remain limited.

Community-focused walking interventions produce improvements in physical activity and are well-received by Latinas when they are socioculturally sensitive. New technology has the ability to provide Latinas with innovative ways to connect socially and increase PA. Location-based services (LBS) are a popular technology that uses geographical positioning to allow individuals to use their smartphones to connect to their surrounding environment.

¡Caminemos Juntas! is a physical activity walking app that uses location-based services to connect Latinas within nearby neighborhoods as a way to provide social support for increased walking behavior. A prototype of the ¡Caminemos Juntas! app was programmed for both iOS and Android smartphones in a previous Phase I project. Multi-method formative research was conducted to guide app design and content prior to conducting field usability testing. To guide prototype development, a national sample of Latinas (n=98; mean age 32.7 +/- 7.8 years; 45% primary Spanish speaking; 28.6% with annual income < $15,000) were surveyed to better understand their preferences, usage, needs, and obstacles of current apps in relation to health and physical activity. Latinas’ current physical activity behaviors and smartphone use, opinions on health-related apps using LBS, how often they access social networking sites on their mobile phone, and their likelihood of using a social networking app to connect to others with intentions to be physically active were also examined.

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

In the new Phase II project, the ¡Caminemos Juntas! app will be fully developed and evaluated in a randomized control trial with Latinas aged 18-45 in San Jose, CA and Denver, CO. Changes in physical activity, social support for exercise, and quality of life will be evaluated. New features to be explored include Fitbit® device integration, mapping of walks, and social media integration. The LBS features of the app will allow Latinas to determine a safe place to meet for a walk, connect with other users nearby, and be notified if there was an available walk in the user’s vicinity.

The research is funded by the National Institute on Minority Health and Health Disparities (MD009652) at the National Institutes of Health through the Small Business Innovation Research Program. Dr. Myers’ collaborators include Dr. Abby King from Stanford University, and Dr. Gary Cutter from Pythagorus, Inc. in Alabama.

Use of AFIX-based Strategies for HPV Vaccination in Florida

Use of AFIX-based Strategies for HPV Vaccination in Florida

Dr. Barbara Walkosz, a Senior Scientist at Klein Buendel (KB), is one of several authors on a recent publication reporting on Florida pediatricians’ use of AFIX-based strategies for human papillomavirus (HPV) vaccination of adolescents and young adults. The report is published in the journal Preventive Medicine. Research collaborators (coauthors) are from the Moffitt Cancer Center and Research Institute, the University of South Florida College of Medicine, Pediatric Partners, the Indiana University School of Medicine, and the Johns Hopkins University School of Public Health.

HPV vaccination is recommended by the U.S. Centers for Disease Control and Prevention (CDC) to significantly reduce the incidence of cervical, vaginal, oral, and other cancers caused by the sexually transmitted virus. A series of vaccinations are recommended for adolescents and young adults, preferably before the onset of sexual activity (9-26 years of age).

However, rates of HPV vaccination in Florida and the U.S. are disappointingly low – less than 50% for girls and less than 40% for boys. In an effort to increase HPV vaccination of pediatric patients, the CDC created and implements the AFIX quality improvement program with healthcare providers. AFIX stands for Assessment, Feedback, Incentives, and the exchange of information – the four key strategies of the program which is delivered to clinics by local health departments.

The Preventive Medicine paper reports on the results of a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida to assess the use of the AFIX strategies. Less than half of the physicians surveyed reported implementing any AFIX strategies, leaving room for program engagement, uptake, and improvement.