Helps and hindrances to passing state indoor tanning laws

Helps and hindrances to passing state indoor tanning laws

Indoor tanning causes skin cancers, including potentially deadly melanoma. Indoor tanning often starts during youth, a critical time for deleterious skin damage. About half of U.S. states have enacted laws banning indoor tanning for minors under the age of 18. A multi-institutional team of researchers including Dr. David Buller and Julia Berteletti from Klein Buendel has published a paper in Translational Behavioral Medicine that reports qualitative findings from interviews with key informants involved in indoor tanning legislative efforts to identify/describe factors influencing law enactment, based on the Multiple Streams Framework (1).

Guided by expert advisors and using snowball-sampling, 64 key informants from 16 states with most recently enacted indoor tanning laws regulating minor access and states without restrictions were contacted. In virtual interviews, key informants shared their unique “story” of indoor tanning bill efforts, enactment, implementation, impact, and potential future directions, which were transcribed and qualitatively coded by trained staff.

Although key informant roles (legislators, advocates, clinicians, and melanoma survivors) and legislative processes vary by state, similar facilitators and barriers to indoor tanning bill passage were identified: personal stories, advocacy, opposition, preparation, legislator education, economic/ enforcement issues, bill stringency, political values/partisanship, and legislative process. Other factors influencing bill enaction included failed U.S. Food and Drug Administration attempts toward federally banning minor indoor tanning and competing priorities.

Despite evidence of laws’ impact on minors’ indoor tanning, policy enaction is challenging and slow. Understanding key facilitators and barriers may help advocates to advance legislation efforts. Advocating for stringent laws necessitates consideration of potential downstream effects. For example, even with policy enactment, key informants believed enforcement and compliance were likely insufficient and variable, with minors continuing to indoor tan, putting them at risk for potentially deadly skin cancer.

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). Authors include Dr. Carolyn Heckman, Ms. Anna Mitarotondo, Mr. Kevin Schroth, and Dr. Shawna Hudson from Rutgers University; Dr. Jerod Stapleton from the University of Kentucky; Dr. Robert Dellavalle from the University of Minnesota; Dr. Sophie Balk from the Albert Einstein College of Medicine; and Dr. David Buller and Ms. Julia Berteletti from Klein Buendel.

References

  1. Kingdon JW. Agendas, Alternatives, and Public Policies. Longman, 2003.
Collaborator Spotlight:
Ms. Anne Poirier

Collaborator Spotlight:
Ms. Anne Poirier

Meet Klein Buendel’s newest research collaborator, Ms. Anne Poirier. She is the originator of the concept of body neutrality, which helps people step away from dieting and redefine their relationships with eating, their bodies, and themselves.

Ms. Poirier is the owner of a body neutrality coaching company and the author of books about self-care and compassion. She graduated from Plymouth State University with a bachelors’ degree in exercise science. She is also a graduate of the Eating Disorder Institute at Plymouth State University and the Life Coach Institute. She is an intuitive eating counselor, a self-talk trainer, and an NSCA-CSCS strength and conditioning specialist. She also serves on the National Eating Disorders Association Lived Experience Task Force.

Ms. Poirier is a nationally recognized body image expert and the author of The Body Joyful and Not a Fat Annie. She is a pioneer and leading voice for the body neutrality movement and has been featured and cited in major media outlets around the word including Shape, Women’s Health, New York Times, Washington Post, Newsy, Livestrong, ABC, and NPR. She is a long-time eating disorder survivor and certified self-talk trainer. She has been a guest on more than 50 podcasts. In 2015, she founded the company Shaping Perspectives…A Woman’s Way to Joy. The cornerstone of the company is the Body Joyful Solution, a coaching program based on the principles of body neutrality.

As her mission is to reduce bullying, body shaming, weight stigma, and eating disorders for the next generation, Ms. Poirier is collaborating with Klein Buendel Scientist, Dr. Kayla Nuss, on NoWeigh!, a novel approach to weight management. The NoWeigh approach emphasizes gratitude for the body’s function, a neutral attitude about the body’s appearance, and engagement in movement that is enjoyable, rather than weight loss. The NoWeigh! Project is funded by an SBIR grant from the National Institute of Diabetes, Digestive and Kidney Diseases (DK142209; Dr. Kayla Nuss, Principal Investigator).

TeenVac to Improve HPV Vaccine Uptake in Adolescent Boys

TeenVac to Improve HPV Vaccine Uptake in Adolescent Boys

Human papillomavirus (HPV) vaccine uptake remains below the Healthy People 2030 goal of 80% series completion in the United States. Parental concerns about the efficacy and safety of the vaccine remain and may be addressed by digital interventions tailored to their concerns.

Dr. W. Gill Woodall, Klein Buendel Senior Scientist, led a large study supported by the National Cancer Institute to increase HPV vaccination among adolescent boys . The results of the study have been published in the Journal of Adolescent Health. Specifically, the paper reports on the purpose, methods, and effectiveness of TeenVac, a mobile app to encourage HPV vaccination in families with adolescent boys.

A randomized trial was conducted between May 2019 and December 2020, testing the mobile web app (teenvac.org) that encouraged HPV vaccination for parents and sons aged 11–14 years old. Parents and 209 adolescent sons were randomized to receive either the TeenVac app or the Centers for Disease Control and Prevention (CDC) HPV vaccination pamphlet online. Participants had access to the TeenVac app or the CDC pamphlet for the 9-month study duration. Adolescent sons’ vaccination records were collected from the state vaccine registry at the end of the study.

Intent-to-treat and web usage analyses were conducted. Intent-to-treat analyses found that adolescent sons of parents randomized to the TeenVac app were significantly more likely to complete the HPV vaccination series than those randomized to the CDC pamphlet group. Web usage analysis confirmed that the TeenVac group parents who used the web app were significantly more likely to have sons complete the HPV vaccination series than those in the CDC pamphlet group.

The TeenVac app meaningfully impacted HPV vaccine series completion, particularly among parents who used the web app. The results provide further evidence that digital interventions can improve vaccine uptake when focused on parents’ and sons’ vaccine-related concerns.

This research was supported by a grant from the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Dr. Woodall’s coauthors include Dr. Gregory Zimet from Indiana University; Dr. Alberta Kong, Dr. Lance Chilton, and Dr. Tamar Ginossar from the University of New Mexico; Jennyfer Reither from Denver Health Hospital; and Dr. David Buller, Lila Martinez, Marita Brooks, and Noah Chirico from Klein Buendel.

Young Adult Melanoma Survivors and Family Member Skin Exams

Young Adult Melanoma Survivors and Family Member Skin Exams

Dr. David Buller, Director of Research at Klein Buendel, is a coauthor on a paper entitled, “Engagement in and correlates of total cutaneous exams and skin self-exams among young melanoma survivors and their family,” in the Journal of Behavioral Medicine.

Young adult melanoma survivors and their close family (first-degree relatives) are at increased risk for developing a melanoma. However, little is known about engagement in and correlates of their clinical skin examination and skin self-examination behaviors. Five hundred and seventy-four (574) young adult melanoma survivors and their first-degree relatives completed an online survey assessing engagement in clinical skin exam and skin self-exam. The survey also included measures of background factors, cognitive and psychosocial factors, clinical skin exam and skin self-exam planning, and family influences.

About 90% of young adults had a clinical skin exam and 90% performed skin self-examination in the last year. Engagement in clinical skin exams among first-degree relatives was lower. Being female, having a physician recommendation, having fewer barriers, and more planning were associated with clinical skin exams. Family influences were not associated with clinical skin exam. For skin self-exams, a physician recommendation and greater self-efficacy were associated with engagement. More comprehensive skin self-examination was associated with a physician recommendation, lower education, greater self-efficacy, and more planning. Stronger family normative influences were associated with more comprehensive skin self-exams among males.

Findings suggest that first-degree relatives may benefit from interventions to improve clinical skin exams and skin self-exams. These results also show that physician recommendation may be a key intervention target to stimulate clinical skin exams and skin self-exams. Examinations are vital for the early detection and effective treatment of melanoma. Details on the significance, methods, analyses, and results of the research may be found in the Journal of Behavioral Medicine manuscript.

This research was supported by a grant from the National Cancer Institute to the Rutgers Cancer Institute of New Jersey at Rutgers University (CA221854; Dr. Sharon Manne, Principal Investigator). Coauthors include Dr. Carolyn Heckman, Dr. Adam Berger, Sara Frederick, Alexandria Kulik, and Morgan Pesanelli from Rutgers University; Dr. Deborah Kashy from Michigan State University; Dr. Sherry Pagoto from the University of Connecticut; Dr. Susan Peterson from the University of Texas; Joseph Gallo from Hackensack Meridian Jersey Shore Medical Center; and Dr. David Buller from Klein Buendel.

MobileMen and mHealth

MobileMen and mHealth

Ms. Amanda Brice, Klein Buendel Project Coordinator, is the lead author on a research paper published in the journal mHealth. The paper reports on the development of MobileMen, a mobile app to promote physical activity in African American men.

African American men experience higher rates of chronic diseases including diabetes, cardiovascular disease, and obesity compared to other race and gender groups. This population also has high levels of inactivity, one of the major risk facts for chronic disease. Due to the promise shown by mobile apps in providing tailored and easily accessible health interventions, the authors set out to design an app to help African American men initiate and maintain their physical activity.

The research team conducted focus groups with 24 African American men to gain insight on the features and design aspects to include in the app prototype. They then used an iterative design process to conduct multiple rounds of beta and usability testing to create a prototype that was easy to use, visually pleasing, and culturally tailored. A satisfaction and helpfulness questionnaire and the System Usability Scale (SUS) were used as quantitative measures in addition to qualitative data provided by participants. Tasks were given to participants to test for ability to navigate and use the app features.

The average satisfaction and helpfulness ratings from participants were 3.9/5 and 3.7/5 for beta testing and 4.3/5 and 4.1/5 for usability testing, which met the pre-determined criteria of ≥3.5. Only one of the satisfaction questions, which was about cultural tailoring for African American men, was below the pre-determined criteria (2.7). By round two of usability testing, most tasks were able to be completed by all participants, and the mean SUS score was 90.36 out of 100 which exceeded a priori feasibility criterion of a mean rating of 68.0. The feedback on the finalized features was positive, and participants expressed that they would use the app if it were on the market.

Based on both the qualitative and quantitative data obtained from multiple iterative design rounds, the MobileMen app was easy to use and contained culturally tailored features. It was well received by the target population and deemed ready to be tested on a larger scale for effectiveness. Full descriptions of the methods, analyses, and findings can be found in the mHealth paper.

This research is funded by an STTR Fast Track grant to Klein Buendel from the National Institute on Minority Health and Health Disparities (MD014947). The Principal Investigator is Dr. Robert Newton from the Pennington Biomedical Research Center. Authors on this paper include Amanda Brice, Steve Fullmer, Charles Barger, Joel Serbinski, Michael Gallik, Dr. David Buller, and Dr. Kayla Nuss from Klein Buendel; Phillip Nauta, and Dr. Robert Newton from the Pennington Biomedical Research Center; Dr. April Stull from Baylor University; Dr. Damon Swift from the University of Virginia; and Dr. Derek Griffith from the University of Pennsylvania. The MobileMen app was designed and programmed by the Klein Buendel Creative Team.

No Weigh!

No Weigh!

Klein Buendel Scientist, Dr. Kayla Nuss, has launched a new research project, funded by the National Institute of Diabetes, Digestive and Kidney Diseases. It will test a novel approach to physical activity promotion. The proposed intervention, NoWeigh!, is a mobile app based on a framework called body neutrality. Body neutrality emphasizes gratitude for the body’s function, a neutral attitude about the body’s appearance, and engagement in movement that is enjoyable, rather than weight loss.

Obesity rates are on the rise in the United States. Weight loss has been the primary recommendation for managing comorbidities with obesity, such as elevated blood lipids and glucose, despite ample evidence that weight loss attempts generally lead to weight regain and weight cycling, which are associated with negative mental health outcomes like anxiety and depression. Experts have called for non-weight loss obesity management, by emphasizing health behaviors such as physical activity. An effective method to deliver physical activity interventions is via mobile apps, of which women are the most frequent users. However, most physical activity apps emphasize weight loss.

The goal of the new Phase I SBIR project is to demonstrate the technical merit and feasibility of developing a smartphone mobile app (NoWeigh!) to support physical activity engagement using the tenants of body neutrality and Self-Determination Theory as frameworks. Mobile health (mHealth) approaches using smartphones offer several advantages for dissemination and implementation of health interventions including that they are portable, typically “on,” readily available, affordable, and offer advanced functionality. In addition, ownership of smartphones among adults is high, enabling potentially vast reach and apps have been shown to improve uptake of, and adherence to, healthy lifestyle strategies.

Project Specific Aims

Aim 1: Perform iterative focus groups in adult women (aged ≥18 years) from diverse backgrounds to collect potential-user information to identify barriers, needs and preferences for a body-neutrality physical activity app design.

Aim 2: Design the conceptual model and develop planned components of the NoWeigh! app which will include storyboards and clickable wireframes.

Aim 3: Conduct beta and usability testing on the clickable wireframes prototype of the NoWeigh! app to show feasibility, acceptability and potential for engagement, and finalize the app design.

Successful completion of Phase I SBIR research will provide evidence to support a larger Phase II project to program and test the full-scale NoWeigh! app in a randomized comparative effectiveness trial. The goal is to produce a commercially ready mobile app for physical activity promotion that does not center on weight loss, a cost-effective lifestyle intervention for decreasing disease risk and reducing healthcare costs. This mHealth approach is an ideal medium for physical activity promotion because the reach, portability, and advanced functionality of mHealth devices allows for effective use by a broad range of adult women.

This grant was awarded to Klein Buendel by the National Institute of Diabetes, Digestive and Kidney Diseases (DK142209; Dr. Kayla Nuss, Principal Investigator). Dr. Nuss’ research collaborator on this project is Anne Poirier. She is the owner of a body neutrality coaching company and the author of the book, The Body Joyful, a guide to a life based on self-care and compassion. The NoWeigh! app will be designed and programmed by the Creative Team at Klein Buendel.

Analysis of Municipal Shade Policies

Analysis of Municipal Shade Policies

Shade is an essential environmental feature to prevent heat illnesses and skin cancer. A research team led by Klein Buendel has published a description of municipal shade policies in Frontiers in Public Health. Written policies related to shade from municipalities in four southwest and four northeast U.S. states were collected and analyzed.

Municipal codes, planning documents, and manuals/guidelines from 48 municipalities in eight U.S. states were coded for content related to shade by research assistants. A standardized protocol was used to assign numeric codes to each document to assess type of document, type of shade, location, resource allocation, accountability, and design standards. Results were summarized using descriptive statistics.

Three-quarters of municipalities (75.0%) had a policy document that addressed shade, including municipal codes (54.2%), planning documents (29.2%), and manuals/guidelines (12.5%). Protecting from heat (31.3%) was mentioned in policies more than protecting from ultraviolet radiation (8.3%), as was natural shade (56.3%) rather than constructed shade (25.0%). Policies prescribed several design standards, most frequently shade material, proportion of area covered, and attractiveness. Half (50.0%) of municipalities mentioned accountability for shade in the policy, but only a third (35.4%) addressed resource allocation. Regional differences were seen in policy document type, shade type, locations, design standards, and resource allocation.

Many municipalities had policies that mentioned shade, but only a minority of policies indicated that the purpose of the policy was protection from heat or ultraviolet radiation. In northeast municipalities, which can have local home rule traditions, policies on shade appeared almost entirely in municipal codes. Southwest municipalities often included policies in planning documents that may have less legal force than municipal codes.

This research was funded by Klein Buendel and a grant from the National Cancer Institute to the Rutgers Cancer Institute at Rutgers University (CA072720; Dr. Steven Libutti, Principal Investigator). Authors include Phoebe Grutter from Science Park High School, Dr. Margaret Morrissey-Basler from Providence College, Dr. Ian Buller from DLH, Dr. Carolyn Heckman from Rutgers University, and Alishia Kinsey, Taylor Sullivan, and Dr. David Buller from Klein Buendel.

In Memoriam: Dr. Erwin Bettinghaus 1930-2025

In Memoriam: Dr. Erwin Bettinghaus 1930-2025

Erwin (Erv) P. Bettinghaus, PhD, Senior Scientist at Klein Buendel, died peacefully on July 7, 2025. Prior to joining Klein Buendel in 2005, Erv was a Senior Scientist at the Cooper Institute, Denver and AMC Cancer Research Center and Dean and Professor in the College of Communication Arts and Sciences at Michigan State University. It was as Dean that Mary Buller, President and Dr. David Buller, Senior Scientist and Director of Research at Klein Buendel first worked with Erv. In 1997, Erv was instrumental in hiring them at AMC Cancer Research Center and its affiliate, Partners for Health Systems.

Erv was an early champion of health communication research and devoted many years to creating effective methods of communicating with Americans about lifestyle changes that would improve their health and prevent disease. He was appointed by President Ronald Reagan to the National Cancer Advisory Board of the National Cancer Institute. He was a member of the research team for the ground-breaking Community Intervention Trial for Smoking Cessation (COMMIT) supported by the National Cancer Institute. After his retirement from Michigan State University, Erv joined AMC Cancer Research Center and initiated its program in health communication research. It was in this chapter of his life that Erv brought together many of the individuals who would create and nurture Klein Buendel. 

Over 20 years at Klein Buendel, Erv had many colleagues and friends and served in important roles at Klein Buendel, including as a Senior Scientist and member of its Board of Directors. He participated on numerous health communication studies as Principal Investigator and Co-Investigator with collaborators both inside and outside Klein Buendel. Most of all, Erv was a mentor to many of us at Klein Buendel, offering timely advice and relentless encouragement for our endeavors.

Klein Buendel’s management and staff feel privileged to have worked with Erv. We celebrate his professional life and friendship. He will be greatly missed.

Visit the Neptune Society for obituary, memorial, and condolence information.

MobileMen Project Protocol

MobileMen Project Protocol

African American men are at higher risk for serious health conditions such as cardiovascular disease, diabetes, and stroke compared to non-Hispanic White men. Physical activity is a modifiable health behavior that has been shown to decrease chronic disease risk. Still, engagement in physical activity is alarmingly low in African American men. While interventions to improve physical activity engagement are effective in several populations, very few have been tailored to the unique needs of African American men. Even fewer have leveraged mobile health apps, despite African American men’s interest in and willingness to use such technologies for health improvement.

Now a multi-disciplinary research team from Klein Buendel, Pennington Biomedical Research Center, and three universities is conducting a comparative effectiveness trial that aims to evaluate MobileMen, a physical activity promotion app tailored to the needs and preferences of African American men. The team has published the plans and methods for the trial in JMIR Research Protocols.

The trial compares the MobileMen app to a commercially available physical activity promotion app with similar features but without culturally tailored components. Specifically, the study is recruiting a sample of 100 “low active” (less than 7500 steps per day) African American men aged 30 years or older from Baton Rouge, Louisiana and its surrounding communities. All participants are given a Fitbit Charge 6 wearable activity tracker to assess daily physical and steps. Participants are randomly assigned to either the MobileMen intervention app or a comparator app. The intervention period is six months, during which participants will interact with their assigned mobile app.

MobileMen includes features such as digital badges earned for physical activity, tangible prizes like exercise equipment, challenges among participants, goal setting, nutrition, physical activity, and behavior change educational information in text, audio, and video formats.

Participants complete assessments at baseline and at six months after random assignment. Assessments include objective measurements of daily steps and minutes of moderate to vigorous physical activity, quality of life, dietary measures, self-efficacy for fruit and vegetable consumption and physical activity, and autonomous motivation for physical activity. Detailed descriptions of measures and methods can be found in the JMIR Research Protocols paper.

Mobile apps are a widely accessible means to disseminate culturally tailored physical activity promotion interventions to various populations, including African American men. MobileMen has the potential to impact physical engagement in African American men, to help improve the overall health and chronic disease risk in this underrepresented population.

This research is funded by an STTR Fast Track grant to Klein Buendel from the National Institute on Minority Health and Health Disparities (MD014947). The Principal Investigator is Dr. Robert Newton from the Pennington Biomedical Research Center. Authors on this paper include Callie Hebert, Phillip Nauta, and Dr. Robert Newton from the Pennington Biomedical Research Center; Dr. April Stull from Baylor University; Dr. Damon Swift from the University of Virginia; Dr. Derek Griffith from the University of Pennsylvania; and Dr. Kayla Nuss, Amanda Brice, and Dr. David Buller from Klein Buendel. The MobileMen app was programmed by the Klein Buendel Creative Team.

Proximity of Alcohol Establishments and Sales of Cannabis to Intoxicated Customers

Proximity of Alcohol Establishments and Sales of Cannabis to Intoxicated Customers

A multi-disciplinary research team led by Klein Buendel presented data from an active polysubstance (alcohol and cannabis) project at the 48th Annual Research Society on Alcohol Scientific Meeting on June 21-25, 2025 in New Orleans, Louisiana.

Dr. David Buller presenting poster

State laws prohibiting sales of alcohol to apparently intoxicated customers are intended to prevent morbidity/mortality from impaired driving, impulsive behaviors, injuries, and violence. A few states (including Oregon) have similar prohibitions for recreational cannabis sales. Compliance with state prohibitions against sales to intoxicated customers by co-located alcohol and cannabis sales establishments was examined in two metropolitan areas in Oregon.

In 2024, actors trained to feign alcohol intoxication visited state-licensed recreational cannabis stores in four counties containing Portland and Salem metropolitan areas and attempted to purchase a low-cost cannabis product while displaying alcohol intoxication. These same actors assessed sales of alcohol products at licensed on-site and off-site alcohol premises located near cannabis stores, using the pseudo-patron protocol. Concordance in refusals (1=both establishments refused vs. 0=else) and concordance in sales (1=both sold vs. 0=else) and point-to-point distances (in kilometers) between alcohol premises and each cannabis store were calculated.

Pseudo-patron teams consisting of a buyer feigning intoxication and an observer assessed 173 cannabis stores and 39 alcohol premises, resulting in 6,747 pairs of establishments. Logistic regression revealed that concordance in refusals (regulatory compliance) was higher in pairs of establishments that were located closer together rather than farther apart. Concordance in sales (regulatory non-compliance) was higher in pairs of establishments that were farther apart rather than closer together, even when examining pairs within the same city and county.

Neighborhood influences on alcohol and cannabis use may arise from the consistency of responsible sales behavior of co-located retailers. When both alcohol and cannabis establishments fail to refuse sales to intoxicated customers, use of alcohol and cannabis and accompanying harms may increase, especially from co-use which can result in high impairment. Community norms associated with, for example, social class or presence of children or regulators’ enforcement efforts may determine similarity in compliance. Responsible vendor training requirements or additional enforcement efforts might reduce co-location effects (neighborhood differences). The small number of alcohol premises and single state somewhat limited the study.

This research is supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA031591; Dr. W. Gill Woodall and Dr. David Buller, Multiple Principal Investigators). Additional collaborating authors include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation; Dr. James Fell from the National Opinion Research Center; Dr. Ian Buller from DLH Corporation, Inc.; Dr. Gary Cutter from the University of Alabama; and Ms. Lila Martinez, Mr. Noah Chirico, and Ms. Amanda Brice from Klein Buendel.