Changes in patients’ family communication after offer of skin cancer genetic test

Changes in patients’ family communication after offer of skin cancer genetic test

Melanoma is a serious preventable form of skin cancer. Genetic testing for skin cancer risk may help increase awareness. A team led by Dr. Jennifer Hay from the Memorial Sloan Kettering Cancer Center, and including Dr David Buller from Klein Buendel, examined how an offer for testing for the melanocortin-1 receptor gene (MC1R) may have enhanced communication surrounding skin cancer within families. The research team presented a poster of their findings at the 44th Annual Sessions and Meeting of the Society of Behavioral Medicine in Phoenix, Arizona on April 26-29, 2023.

The study examined frequency targets (which family member) and topics of family communication around skin cancer at a 3-month follow-up within a New Mexico study that randomized primary care patients (N=600; 48% Hispanic) to MC1R test invitation or usual care (Aim 1). Frequency and targets were assessed on 4-point scales (“not at all” to “a lot”) asking participants how often they talked with family and with each target. Topics were assessed by asking participants whether they discussed a series of topics with family. The impact of usual care genetic test refusal and test results (average or higher risk feedback) on frequency targets and topics of family communication was assessed using ANOVAs and Chi-Square tests (Aim 2).

Aim 1 analysis showed that at the 3-month follow-up the average frequency of overall family communication was between “a little” and “some”. The most common communication targets were spouses and children; the most common topic was sun protection. Aim 2 analysis showed no significant differences in communication frequency. However, communication targets who received high-risk feedback reported greater communication with their spouse compared to those in usual care. Lastly, the study found that certain topics of communication such as “who had skin cancer in the family” and “your own risk of getting skin cancer” were discussed more by those who had testing (both receiving average and high-risk feedback) than by those in usual care or by test refusers.

The findings provide important insight into family communication about skin cancer. The results indicate greater discussion with certain people and about certain topics when individuals had undergone genetic testing highlighting the potential role that genetic testing can play in fostering family communication. Future research could provide deeper insight into why individuals talk to certain people and about certain topics more than others as well as examine how family communication affects decision-making regarding offers for cascade genetic testing or interpretation of results.

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 Dr. Jennifer Hay include Ms. Caroline Salafia (poster presenter), Dr. Smita Banerjee, and Ms. Elizabeth Schofield from the Memorial Sloan Kettering Cancer Center; Dr. Andrew Sussman, Dr. Dolores Guest, 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.

Physical Activity Research with Apps and Wearable Trackers

Physical Activity Research with Apps and Wearable Trackers

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

Dr. Kayla Nuss at SBM

Presentation 1: Poster Session

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

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

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

Presentation 2: Symposium 1

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

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

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

Presentation 3: Symposium 2

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

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

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

Presentation 4: Paper Session

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

Presenter: Dr. Ryan Rhodes

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

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

Stringency of State Indoor Tanning Laws

Stringency of State Indoor Tanning Laws

Approximately five million cases of skin cancer are diagnosed among Americans at a cost nearing $9 billion annually. Indoor tanning (IT) is a risk factor for skin cancer. Restricting IT facilities, especially access by minors, has been the subject of state laws. More stringent restrictions on youth access (for example, bans by age vs. parental consent laws) appear to be associated with reduced IT by youth.

Julia Berteletti and David Buller at SBM

A team led by Dr. Carolyn Heckman from Rutgers University and Dr. David Buller from Klein presented a poster characterizing the IT policy landscape of U.S. states at the 44th Annual Sessions and Meeting of the Society of Behavioral Medicine in Phoenix, Arizona on April 26-29, 2023. The poster was entitled “Comparison of the stringency of indoor tanning bills regarding minors that passed and failed in state legislatures over the last 30 years.”

The research team coded 107 state IT law documents and compared passed laws to failed bills (proposed but not voted on or proposed but voted down), using a validated coding tool that assessed the presence of age bans, parental consent/accompaniment, warnings, operator requirements, and enforcement. Component codes were scaled on 10-point stringency measures (0=no regulation, 10=very strong regulation). Component and total summed scores were calculated, with higher scores indicating more stringent IT restrictions.

Between 1991 and 2022, 46 states and the District of Columbia passed a law on IT, with 23 banning access to IT facilities by minors under age 18. By contrast, 60 bills on IT failed to pass in 31 states since 2008. However, stringency of laws is weak, overall, which may explain why recent research found low compliance of IT facilities with regulations and continued IT among minors. Failed bills without minor bans were less stringent than similar passed laws, on nearly all components. Failure may have presented advocates opportunities to improve stringency of subsequent bills and time to garner more support for IT restrictions. In fact, less stringent bills may have failed because they had less support from outside constituencies (for example, medical societies and public health advocates) and among legislators. To gain insight into this public health legislation process, we are interviewing key informants from states with recent policy activity.

This research was supported by a grant to Rutgers University from the National Cancer Institute (CA244370; Dr. Carolyn Heckman and Dr. David Buller, Multiple Principal Investigators). Co-authors included Ms. Julia Berteletti from Klein Buendel and Ms. Anna Mitarotondo from Rutgers University.

Usability Testing of Just Care Modules in Prisons

Usability Testing of Just Care Modules in Prisons

Prison population demographics are shifting such that many people will grow old and spend their final days in prison. Research evidence supports using peer caregivers to assist prison staff with providing supportive care. However, the training received by peer caregivers varies widely. Evidenced-based, accessible, and contextually relevant learning materials are needed to effectively prepare peer caregivers for their role.

A research team from The Penn State University Ross and Carol Nese College of Nursing and Klein Buendel have developed Just Care, a six-module e-learning program designed to augment the face-to-face training that is typically provided to peer caregivers. Small-scale usability testing of the Just Care program was conducted with twenty men and women, who are incarcerated, and ten staff members at one men’s and one women’s state prison in a southeastern state. Two rounds of usability tests were conducted via a video-conferencing platform. The results of the usability tests were recently presented at the annual conference of Academic Consortium on Criminal Justice Health (ACCJH) in Raleigh, North Carolina on April 13-14, 2023.

Most users, who were incarcerated, did activities without aid and no tasks or programming issues were identified that made it impossible to use the application as intended. However, a few usability and content issues were noted including: (a) some users did find the x-ray scanner activity challenging when trying to drag the scanner across the body image to reveal symptoms as death approaches; and (b) a few staff users noted that the returning citizens’ video testimonials in the Staff Module lacked racial diversity.​

The System Usability (SUS) scores for each round respectively were 87.5 (incarcerated), 74.5 (staff); and 85.28 (incarcerated), 83.75 (staff). A SUS score of 68 is considered above average. Overall, both participant groups found Just Care easy to navigate with content that is interactive, useful, engaging, and relevant. Prison staff noted that Just Care raised awareness about peer caregivers’ need for training to help care for older people in prisons.

Next steps for the research team is to address the issues raised in the usability tests and prepare for large-scale usability testing to be conducted in state prisons in the summer and fall of 2023. This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging [AG057239; Dr. Susan Loeb (Penn State) and Dr. Barbara Walkosz (Klein Buendel), Multiple Principal Investigators]. Collaborators on the ACCJH poster presentation also included Dr. Erin Kitt-Lewis, Sherif Olanrewaju, and Katherine Aiken from The Penn State University; and Brandon Herbeck and Steve Fullmer from Klein Buendel. 

Effects of Motivational Interviewing and Wearable Fitness Trackers on Motivation and Physical Activity in Inactive Adults

Effects of Motivational Interviewing and Wearable Fitness Trackers on Motivation and Physical Activity in Inactive Adults

Despite tremendous adoption of wearable fitness trackers by adults, it is unclear if they affect physical activity engagement or motivation. In a paper published in the Journal of Sports Sciences, Dr. Kayla Nuss, Klein Buendel Scientist, and her research collaborators reported on a study to examine the combined effects of motivational interviewing and wearable fitness trackers on motivation and physical activity in inactive adults.

The authors hypothesized that combining a wearable fitness tracker (such as a FitBit®) with an effective intervention (motivational interviewing), would positively influence both motivation and physical activity. To test the hypothesis, a 12-week randomized controlled trial was conducted with 40 adults who did not meet physical activity recommendations. The four comparison groups were: (1) physical activity education only (educational control) with 10 participants, (2) use of a wearable fitness tracker (WFT) with 10 participants, (3) bi-weekly motivational interviewing sessions with 10 participants, or (4) both motivational interviewing and WFT (WFT+) with 10 participants.

Motivation and physical activity were measured though an online survey and actigraphy (a method to objectively estimate physical activity) pre- and post-intervention. Both the WFT+ and motivational interviewing groups scored higher in autonomy, competence, and relatedness for physical activity compared to the control group, which is associated with higher quality, or more autonomous forms of motivation. Further, both groups did show improvements in autonomous forms of motivations (such as interest or enjoyment) and decreased controlled forms of motivation (such as pressure or reward). Detailed descriptions of the study’s methods, recruitment efforts, measures, data analysis, outcomes, and limitations can be found in the Journal of Sports Sciences publication.

The authors detected no changes in physical activity. High autonomous motivation at baseline predicted higher post-intervention physical activity in the WFT+ group, but predicted lower post-intervention physical activity in the WFT group. The results of the study suggest that motivational interviewing alone or with a wearable fitness tracker can improve basic psychological needs and autonomous forms of motivation for physical activity, but not physical activity participation. The authors conclude that individual differences in motivation at baseline may moderate the effect of a wearable fitness tracker on physical activity. The findings add to the growing body of evidence that wearable fitness trackers can have some positive effect on adult’s physical activity.

This research was supported by Colorado State University Department of Health and Exercise Science (Dr. Kayla Nuss, Project Director). Collaborating authors included Ms. Kristen Moore from the University of Southern California; Dr. Tasha Marchant from the University of Colorado Health Sciences Center; Dr. Jimikaye Beck Courtney from the University of North Carolina-Chapel Hill; and Ms. Kathryn Edwards, Dr. Julia Sharp, Dr. Tracy Nelson, and Dr. Kaigang Li from Colorado State University.

Collaborator Spotlight:
Dr. Robert Saltz

Collaborator Spotlight:
Dr. Robert Saltz

Dr. Robert Saltz

Robert Saltz, Ph.D. is a Senior Research Scientist at the Prevention Research Center within the Pacific Institute for Research and Evaluation (PIRE) in Berkeley, California. He received his Ph.D. in Sociology from the University of Massachusetts. His research explores ways in which drinking context may influence the risk of subsequent injury or death. He has extensive experience researching “responsible beverage service” programs aimed at having bar and restaurant personnel intervene with patrons to reduce the risk of intoxication or driving while impaired.

Dr. Saltz collaborated with Dr. W. Gill Woodall and Dr. David Buller from Klein Buendel on the development, evaluation, and commercialization of the WayToServe® responsible beverage service training program in English (AA014982; W. Gill Woodall, Principal Investigator) and Spanish (MD010405; Dr. W. Gill Woodall, Principal Investigator), and the TrainToTend® responsible cannabis vendor training program (DA038933; Dr. David Buller, Principal Investigator).

Currently, Dr. Saltz is working with Dr. Buller and Dr. Woodall on two research projects. One is a PIRE project to assess the impact of California’s new mandatory responsible beverage service (RBS) training law intended to prevent alcohol-involved motor vehicle crashes and other harms. The research is funded by the National Institute on Drug Abuse (Dr. Robert Saltz, Principal Investigator). The study is examining whether there is a significant reduction in single nighttime motor vehicle injury crashes after implementation of the mandatory responsible beverage service training law, controlling for other factors in California that may influence this outcome, and the national trend in fatal alcohol-involved motor vehicle crashes. The training program that will be implemented is the WayToServe® online RBS training program developed and evaluated by PIRE, Klein Buendel, and the University of New Mexico.

The other is a Klein Buendel project developing and testing an in-service professional development component for alcohol servers trained by WayToServe to enhance its effectiveness. WayToServe Plus is intended to motivate servers to implement the responsible beverage service skills in the face of common barriers, provide support for responsible beverage service actions from a “community” of alcohol servers, and prevent natural degradation of skills over time. The in-service training is delivered through the WayToServe Facebook page that currently is followed by over 20,000 alcohol servers trained by WayToServe. This project is funded by the National Institute on Alcohol Abuse and Alcoholism (AA029364; Dr. W. Gill Woodall and Dr. David Buller, Multiple Principal Investigators).

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Scaling Media Literacy in a School District Environment

Scaling Media Literacy in a School District Environment

Implementation science, the study of methods and strategies that facilitate the uptake of evidence-based practices, is emerging as a framework to study the application of media literacy. Implementation science emerged in the public health field, and is just becoming known and applied in media literacy programs.

A research team led by Dr. Tessa Jolls from the Center for Media Literacy in California, and including Dr. Barbara Walkosz from Klein Buendel, conducted a panel discussion at the Global Media Education Summit held March 2-4, 2023 at Simon Fraser University in Vancouver, Canada. The panel was entitled, “Implementation Science: The Road to Scaling in a District Environment.” Two additional panelists included Dr. Marilyn Cohen from the University of Washington and Ms. Heather Van Benthuysen from the Chicago Public Schools.

The research team discussed the rising field of implementation science and presented an example underway in a U.S. school district. Relying on theories of change and rigorous evaluations of programming that exemplify these theories of change, the panelists described how implementation science provides a solid foundation for dissemination, scaling, and helping media literacy take its rightful place as a central educational offering. The panelists illustrated how implementation science works to strengthen and sustain media literacy in schools.

The Global Media Education Summit is convened by the UK’s Centre for Excellence in Media Practice, in collaboration with a leading media education space, in a different country each year. In 2023, the School of Communication and the Community Engaged Research Initiative at Simon Fraser University hosted the event, in partnership with the McLuhan Foundation. The Global Media Education Summit brings together an international network of researchers, educators, and practitioners across all aspects of media education, media and digital literacies, youth media production and media and technology in education. As the leading global showcase for research, pedagogy, and innovation, the Summit explores the changing currents across media education and media literacy communities around the world.

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

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

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

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

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

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

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

Adapting a Sun Safety Program for Low-Risk Outdoor Workers

Adapting a Sun Safety Program for Low-Risk Outdoor Workers

Ultraviolet radiation (UV) from the sun is an occupational hazard that causes skin cancer. Outdoor workers are disproportionately Hispanic and African American (AA). Though risk for skin cancer is greater for non-Hispanic Whites, Hispanics and AAs are more likely to die from skin cancer as a result of delays in detection. Interviews (n=32) and an online survey (n=81) were conducted with a predominantly male, Hispanic, and AA sample of outdoor workers to inform the systematic adaptation of an existing evidence-based workplace sun safety program. The goal was to learn how to target messaging to underrepresented outdoor workers with darker skin types.

The interview sample was largely male (87%), Hispanic (78%), and AA (25%). Interviews were qualitatively reviewed to identify common themes. Most employees reported not getting sunburned while at work. Some reported skin darkening as a negative consequence. Sun protection is not a topic usually discussed with others but skin cancer is a concern. They reported engaging in sun protection, but not frequently wearing sunscreen. They were positive about receiving sun safety training at work and suggested it be combined with heat stroke prevention, which is a common training topic. The survey sample also was largely male (74%), Hispanic (25%), and AA (58%). Respondents reported an average of 2.66 sunburns in the past year, 85% occurring at work. They learned about sun protection most often from parents (46%), followed by employers (37%) and healthcare providers (37%). Only half (49%) reported being very confident they can practice sun safety. Limiting time outside during high UV (46%) and wearing sunscreen (35%) were the least used forms of sun protection reported. Participants in the interviews and survey listed avoiding sunburn, preventing skin darkening, and preventing heat stroke as benefits of sun safety training.

Overall, employees with darker skin types knew about UV protection and often put the knowledge into practice on the job. Motivation based on perceived risk for skin cancer and self-efficacy could be improved, especially with regard to sunscreen. Other appearance and health concerns, such as preventing heat illnesses in this period of climate-driven extreme heat events, may be highlighted to motivate sun protection among outdoor workers with darker skin types. Employers are an important source of sun safety information for these employees, since many do not talk about it with other people in their lives.

This formative research is supported by the National Cancer Institute of the National Institutes of Health under award number CA257778 (Mary Buller, Klein Buendel President, Principal Investigator). Collaborators from Klein Buendel include Dr. Barbara Walkosz, Ms. Julia Berteletti, and Ms. Irene Adjei.

EUROGIN HPV Panel Presentation

EUROGIN HPV Panel Presentation

Klein Buendel Senior Scientists, Dr. W. Gill Woodall and Dr. David Buller, presented two research projects in a panel discussion at the EUROGIN International Multidisciplinary HPV Congress on Feb 8-11, 2023 in Bilbao, Spain. The “Digital Interventions to Increase HPV Vaccination” panel featured four presentations and was moderated by Dr. Greg Zimet from the University of Indiana. Other Klein Buendel scientists and staff (at the time of abstract submission) contributing as co-authors included Dr. Barbara Walkosz, Ms. Marita Brooks, Ms. Lila Martinez, and Ms. Jeanny Reither. Klein Buendel employees’ names are bolded.

Presentation 1

Title: “Randomized Trials of HPV Vaccine Uptake Improvement: Web Apps for Parents and Young Adolescent Girls and Boys”

Presenter: W. Gill Woodall, PhD, Senior Scientist, Klein Buendel, Inc. Albuquerque, NM, USA

Co-authors: A. Kong, G. Zimet, D. Buller, L. Chilton, J. Reither, L. Martinez, M. Brooks

This presentation discussed the results of two randomized trials of parent-focused web apps to improve HPV vaccine uptake for young adolescents (ages 11-14).  For the first trial, the web app was tailored to parents and young adolescent girls, and in the second trial, the web app was tailored to parents and young adolescent boys. Results of both trials indicated significant web app impact on HPV vaccine uptake for adolescent girls and boys, as well as other vaccine uptake related variables.  The discussion included a consideration of web app content and tailoring to determine HPV vaccine uptake improvement.

Presentation 2

Title: “Successful technology-based rural patient HPV vaccination reminder intervention and social media assessment of strategies to reduce HPV vaccine misinformation”

Presenter: Deanna Kepka, PhD, MPH, University of Utah, Salt Lake City, UT, USA

Co-authors: K. Christini, E. McGough, B. Gibson, E. Warner, H. Brandt

This presentation described a multi-level and multi-component intervention that included healthcare team training activities and technology-based HPV vaccination reminders. Missed opportunities for HPV vaccination declined significantly from the pre-intervention to the post-intervention period. Participants who recalled receipt of an electronically delivered vaccination reminder had higher unadjusted odds of scheduling a visit compared with those who did not recall receiving a reminder. Social media-delivered misinformation related to HPV vaccination is pervasive. The presenters also discussed new strategies to evaluate and reduce the impact of HPV vaccine misinformation in rural settings.

Presentation 3

Title: “Promoting HPV vaccination to emerging adults in rural communities in a multi-risk factor cancer prevention social media intervention”

Presenter: David Buller, PhD, Senior Scientist, Klein Buendel, Inc., Denver, CO, USA

Co-authors: A. Sussman, D. Kepka, W. G. Woodall, E. Warner, B. Walkosz

This presentation described an innovative social media campaign targeting six cancer risk factors, including HPV vaccination. It is being developed for the diverse population of adults aged 18-26 in rural counties in the Mountain West region of the U.S. Emerging adults obtain health information online far more than information from health care providers and other media. A framework for social media message development was presented based on social cognitive, self-determination, and diffusion of innovation theory. Misinformation, especially on vaccination, will be combatted by instructing emerging adults in digital and media and by using an epidemiological model of monitoring and quickly responding to correct misinformation. The campaign will be tested with a sample of 1000 emerging adults in a stepped-wedge quasi-experimental design.

Presentation 4

Title: “U.S. National Digital Point of Care Communication to Improve Uptake of HPV and Other Adolescent Vaccines in Clinic Settings”

Presenter: Judy Klein, BA, BS, President, UNITY Consortium, Philadelphia, PA, USA

Co-authors: G. Zimet, V. Agadi, C. Hu, A. Jaramillo

This presentation reported on a study that involved digital targeted adolescent vaccination infographics and videos widely disseminated to clinical practices throughout the U.S. Over 11,000 clinicians whose practices received these digital interventions (exposed condition) were matched to an equal number of non-exposed comparison practices matched on multiple practice characteristics. The outcomes of interest were the number of vaccine doses (Tetanus-diphtheria-pertussis booster or Tdap, HPV, MenACWY, and MenB) administered to patients 11-18 years of age. The exposed clinics showed significant increases in administration of adolescent vaccines, including HPV vaccine, compared to the non-exposed clinics.