KB Collaboratory - Research, Technology, & Health Communication

Collaborator Spotlight:
Dr. Victoria Sánchez

June 19, 2018 Klein Buendel

Dr. Victoria Sánchez is an Associate Professor in the College of Population Health at the University of New Mexico (UNM) in Albuquerque. She earned her MPH at the University of California at Berkeley and her Doctorate in Public Health (DrPH) in Health Behavior and Health Education at the University of North Carolina at Chapel Hill. She directs the MPH Community Health Concentration track at UNM and teaches social and behavioral sciences courses for the UNM College of Public Health.

Dr. Sánchez has a long-standing commitment to participatory planning and evaluation processes with communities and public health organizations. Over the last thirty years, she has integrated her expertise in public health practice and participatory and multidisciplinary research methodologies to plan and implement joint solutions for reducing health and social disparities in Latino and other vulnerable communities. As a member of multidisciplinary teams, she has applied social and cultural theories and models in the development, tailoring, testing, and evaluation of interventions to improve the health of Latinos/Hispanics in New Mexico, Texas, and California.

Currently, Dr. Sánchez is working with Klein Buendel as a collaborating scientist with Dr. Gill Woodall and Dr. David Buller on WayToServe Español: A Culturally-Appropriate Online Responsible Beverage Service Training for Spanish-Speaking Servers (R44MD010405; Dr. Gill Woodall, Principal Investigator). This research project is funded by the National Institute on Minority Health and Health Disparities. Dr. Sánchez collaborates on the creation and evaluation of culturally-appropriate content and the translation of the English WayToServe® online training program to Spanish. She helps ensure that the translation is compatible with the values and needs of servers in Spanish language-dominant bars and restaurants. The randomized control trial is being conducted at Spanish-dominant businesses in the Southwestern region of the United States. …

Skin Cancer Prevention Messages on Facebook

June 12, 2018 Klein Buendel

Social media use among American adults has grown over the years – from just 5-in-10 in 2011 to seven-in-ten in 2018 – and reasons for using social media range from connecting with others to accessing news content to sharing information.¹ With skin cancer still the most common among all cancers,² it seems logical to use social media to promote and spread skin cancer prevention awareness. But is it effective?

In a recently published article in the Journal of the American Academy of Dermatology, KB’s Dr. Barbara Walkosz and Rachel Eye, along with other collaborators, aimed to review and classify skin cancer prevention messages from non-profit organizations on Facebook to determine which types garnered high engagement, such as likes, comments, and shares. Messages were identified using the following keywords: “skin cancer prevention,” “melanoma,” “melanoma prevention,” and “sun safety.” From May 2014 to May 2015, Facebook pages of 24 skin cancer groups’ and their 824 Facebook messages were coded for the following content: message format (narrative or didactic), motivation (skin cancer risk or appearance), persuasive appeal (social norm, fear, humor, altruism, celebrity story), behavioral target (sunscreen, hats, shade, avoid sunburn, indoor or outdoor tanning, skin exams), imagery, image content, and hyperlink. Engagement and frequency of message types were also determined.

Authors found that the majority of messages were didactic and focused on skin cancer occurrence and type but note that these approaches are not always effective in producing behavior change. Furthermore, the top three behavioral targets addressed were skin exams, indoor and outdoor tanning, and sunscreen use. Messages that were more didactic, appearance-based, myth-busting, used celebrity endorsements, and targeted self-exams received the most engagement. Messages without images received a higher rate of likes, shares and comments compared with messages that included images.

Limitations of the study include the inability to determine if those following the pages studied are representative of populations at risk for skin cancer and the potential of missed messages based on the keywords used for inclusion criteria. Authors state that collaborations between health institutes and researchers could identify characteristics of messages that are both effective for behavior change and produce high engagement rates in order to have the greatest impact on skin cancer prevention.

References

Social media fact sheet. Pew Research Center Web site. Available at: http://www.pewinternet.org/fact-sheet/social-media/. Published February 5, 2018. Accessed April 24, 2018.
Key statistics for melanoma skin cancer. American Cancer Society Web site. Available at: https://www.cancer.org/cancer/melanoma-skin-cancer/about/key-statistics.html. Updated January 4, 2018. Accessed April 24, 2018.

Real Health Photos – National Safety Month

June 5, 2018 Klein Buendel

For 100 years, the National Safety Council has been the leading safety advocate preventing unintentional injuries and death in the United States. The Council’s National Safety Month, Observed annually in June, focuses on reducing leading causes of injury and death on the job, on the road, in the home, and in all communities. Specific areas they address include workplace violence prevention, safe driving, poisoning prevention, ergonomics, and fall prevention.

More than 33,000 people, for example, died in falls in 2015, according to the National Safety Council. “Falling is the third leading cause of unintentional injury-related deaths over all age groups, but it’s the #1 cause of death for those 65 and older” (Injury Facts 2017, National Safety Council). Strategies for preventing falls include securing carpets to the floor, wiping up spills immediately, installing grab bars in tubs, in showers, and near toilets, and if necessary, provide personal walking devices, such as canes or walkers, to aid in stability.

Klein Buendel’s Real Health Photos stock photography enterprise includes numerous images of older adults using personal walking devices. These unique photographs can be used in educational materials to show older adult populations how easy and typical it is for people to use devices for safe walking.

Real Health Photos images show a diversity of gender, race, ethnicity, age, income level, and health condition. Use Real Health Photos for improving the impact of health campaigns for people from all walks of life, including older adults.

For more images, visit Real Health Photos.

Real Health Photos is a stock photography service owned and operated by KB. It was created and evaluated with a research grant (R44MD003338, Mary Buller, Principal Investigator) from the National Institute of Minority Health and Health Disparities at the National Institutes of Health. Real Health Photos is designed to capture the diversity of health through photography and promote the inclusion of all populations in health promotion materials and media.

Real Health Photos® is a KB registered trademark.

BeVaccinated Web App Usability Testing

May 29, 2018 Klein Buendel

Dr. W. Gill Woodall from Klein Buendel and the University of New Mexico presented findings from the BeVaccinated project at the 68^th Annual Conference of the International Communication Association in Prague, Czech Republic, May 24-28, 2018. The project tested the usability of a prototype web app for improving adolescent vaccination uptake.

While vaccination rates for young children in the U.S. currently meet recommended standards, the CDC reports adolescent vaccines uptake (Gardasil 9 for HPV, MCV4 for meningococcal infection, Tdap for Tetanus, Diptheria and Pertussis protection, and Varicella vaccine for Chickenpox protection) to be less than optimal. In the case of the Human Papillomavirus (HPV) vaccine, rates are seriously below desired uptake levels. Despite established safety and effectiveness information about these vaccinations, and a wide variety of medical organizations recommending them, parents continue to have concerns about them, particularly the HPV vaccine.

For health communication researchers focused on Diffusion of Innovations, this is a classic difficulty of lack of effective messaging to prompt the uptake of an innovation by closing a knowledge gap among parents, in this case, on effective adolescent vaccines. The CDC and the Presidents Cancer Panel call for the development of effective and accessible messaging to improve vaccine decision-making as well as uptake. Because parents drive the decision to, and action for, vaccine uptake, messaging should be focused on them, but not exclusively, as there are benefits from parents and adolescents communicating about vaccines specifically and health issues generally. Approaching the vaccines as a recommended adolescent vaccine panel instead of each vaccine singularly may provide adoption benefit, as a vaccine panel approach builds the normative expectation for getting all adolescent vaccines as a group.

To address this vaccine uptake deficit, a web-browser application prototype, BeVaccinated, was developed to test reactions to and feasibility of delivering adolescent vaccine information via a smartphone. The majority of adults of parenting age own smartphones and use them to access online information, especially minority adults, and use mobile apps for information acquisition and decision support, making them a potentially efficacious channel for delivering vaccine information and tools. The prototype app was developed via formative research with focus group participants and guided by an Expert Advisory Board (EAB) comprised of vaccination experts and clinicians. Usability testing was conducted iteratively with nine parent and teen pairs in New Mexico and seven parent and teen pairs in Colorado. Pairs were comprised of one teen, ages 13-17, and their accompanying parent or guardian.

Usability testing was conducted individually with the parent and teen by trained research staff. Parents and teens reported that the prototype app was easy to use. Users reported that they could learn to use it quickly and that they were confident using it. With feasibility established, the full version of the app will be designed to improve dissemination of vaccine information, improve parent/teen communication around health behavior choices, and ultimately, improve the uptake of vaccinations.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R41HD082901; Dr. W. Gill Woodall, Principal Investigator). Collaborators included Julia Berteletti from KB; Dr. Randall Starling, Dr. Alberta Kong, and Dr. Lance Chilton from the University of New Mexico; Dr. Greg Zimet from Indiana University; and Dr. Nathan Stupiansky from the University of Arizona.

Effects of the Sun Safe Workplaces Program

May 24, 2018 Klein Buendel

Occupational skin cancer prevention is an international priority. People who work outdoors are routinely exposed to high levels of ultraviolet radiation (UV), the primary risk factor for skin cancer. Dr. Barbara Walkosz from Klein Buendel presented findings from the Sun Safe Workplaces project and a follow-up assessment at the 68^th Annual Conference of the International Communication Association in Prague, Czech Republic, May 24-28, 2018.

Sun Safe Workplaces (SSW) was a communication theory-based workplace sun safety program for public organizations that employ people who work outdoors. Examples of outdoor work include road and bridge work, parks and recreation facilitation, sanitation and water works, and public safety. The original SSW project promoted the adoption of workplace sun safety policies in the public organizations and provided training in personal sun protection for outdoor workers in a randomized controlled trial. The follow-up study assessed the impact of SSW on employee sun safety behavior.

Sixty-one of the 98 public employers from the original study participated. Managers and line supervisors reported program implementation. A total of 1,784 outdoor workers (913 from the intervention group and 871 from the control group) completed surveys on personal sun protection practices.

In summary, employees’ sun protection improved statistically significantly in the intervention group receiving the SSW program. SSW’s effect on employee sun protection was mediated by the number of workplace actions to implement elements of sun safety policy including sun protection messages and equipment in the workplace and employee reports of training in sun safety.

This research was funded by a grant from the National Cancer Institute (RO1CA187191; Dr. David Buller, Principal Investigator). In addition to Dr. Walkosz and Dr. Buller from Klein Buendel (KB), collaborators/co-authors included Mary Buller from KB; Dr. Allan Wallis from the University of Colorado Denver; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; Dr. Michael Scott from Mikonics, Inc.; Dr. Peter Andersen from San Diego State University; and Dr. Gary Cutter from the University of Alabama, Birmingham.

KB Receives Train to Tend® Trademark

May 18, 2018 Klein Buendel

Klein Buendel has received trademark registration through the U.S. Patent and Trademark Office (USPTO) for the Train To Tend® product name and logo. This is the sixth registered trademark for a KB-owned or co-owned product. KB also has registered trademarks for the following technology-based health education programs:

Real Health Photos® – a stock photography website of diverse, under-represented people
Way To Serve® (with the University of New Mexico) – an online responsible alcohol server training program
Sunny Days, Healthy Ways® – a sun safety curriculum for grade K-5
Momzing® – a collection of videos for moms to exercise with their babies and toddlers
sunZapp® – a mobile phone app for personal sun protection advice

According to the USPTO, “A trademark is a brand name. A trademark or service mark includes any word, name, symbol, device, or any combination, used or intended to be used to identify and distinguish the goods/services of one seller or provider from those of others, and to indicate the source of the goods/services.”

The Train To Tend® logo was designed by Steve Fullmer, KB Creative Director, for a research project funded by the National Institute on Drug Abuse (R44DA038933). The Principal Investigator for the study is Dr. David Buller, KB Director of Research. His KB lead Co-Investigator is Dr. W. Gill Woodall, KB Senior Scientist. This project’s specific aims are to produce a comprehensive, compliant online responsible marijuana vendor training program —TrainToTend®. The training for the retail and recreational marijuana industry is intended to increase knowledge of state regulations for the sale of cannabis products in states that have legalized recreational cannabis, such as Colorado, Oregon, and Washington. The training also covers responsible sales practices, such as ID checking, safe storage, robbery prevention, the health effects of marijuana, and other industry-related content.

Cost of Occupational Sun Protection Policy Intervention Delivery

May 14, 2018 Klein Buendel

Dr. Richard Meenan presented cost analysis data from the Sun Safe Workplaces project at the 4^th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focused on an estimated cost of delivering a sun protection policy intervention to public-sector employers in Colorado. The cost of occupational skin cancer prevention interventions poses challenges for organizations delivering interventions and employers that implement sun protection for outdoor workers.

The Sun Safe Workplaces (SSW) intervention promoted occupational sun protection policies and education to 98 public-sector employers in a randomized controlled trial. Intervention components included in-person meetings and follow-up contact by email and telephone with senior managers, in-person trainings for employees, and printed educational materials sent to the workplace. Using a micro-costing approach, costs to the intervening organization were determined from the project accounting system supplemented by external sources. Costs to employers were estimated from responses to semi-structured interviews in a two-year follow-up with 34 senior managers on implementing sun protection education and other actions to support employee sun safety and were presented at the conference. Employers incurred highest average costs for implementing onsite sun safety training, primarily the estimated value of employee time in attendance.

Costs to employers are likely a barrier to acting on skin cancer prevention. In the SSW trial, employers appeared to incur more costs than the intervening organization. Strategies to control employer costs should be considered when designing occupational skin cancer prevention interventions. Costs will be used to determine: (1) the incremental cost of the SSW intervention (ignoring development and research costs) and (2) the incremental cost of the employers’ skin cancer prevention education and policy adoption actions induced by the SSW intervention.

This research was funded by a grant from the National Cancer Institute (RO1CA187191; Dr. David Buller, Klein Buendel, Principal Investigator). Collaborators include Dr. Barbara Walkosz, Rachel Eye, and Mary Buller from Klein Buendel; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; and Dr. Allan Wallis from the University of Colorado Denver.

Klein Buendel was one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Sun Safety Ink!

May 7, 2018 Klein Buendel

Dr. Robert Dellavalle presented Sun Safety Ink! at the 4^th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focused on formative research conducted by Klein Buendel and the University of Colorado Denver to develop a skin cancer prevention training program for tattoo artists.

Twenty-five percent (25%) of American adults have a tattoo, and higher rates are found among younger generations. Sun safety promotions to young adults are significant because risk factors are elevated for this population. Tattoo artists may be ideal sources for delivering effective sun safety interventions to this hard-to-reach, at-risk population because sun safety is recommended for tattoo aftercare and the long-term.

Semi-structured interviews with tattoo artists and focus groups with tattooed individuals gathered input on the design of the Sun Safety Ink! (SSI!) online training program for tattoo artists. Tattoo artists had limited knowledge of skin cancer but reported that they alert clients if they observe skin abnormalities. All artists provided written and verbal aftercare instructions that included sun safety recommendations, but only for tattoos. Artists were interested in the SSI! training program. They suggested the use of video training scenarios to help artists learn to communicate with clients and that information about skin cancer (such as statistics and causes), conversation starters, and examples of sun safety practices be included.

Focus group participants had low levels of sun protection. Participants reported most artists do not discuss health topics but were positive about receiving skin cancer prevention messages, especially during lengthy tattoo sessions. Participants noted that sun safety advice from an artist might make a difference in protecting all of their skin not just tattoos. They recommended that artist deliver sun protection information multiple times while the client is getting the tattoo, during follow-up visits, by text message, in aftercare instructions with pictures or skin cancer facts, and via social media.

Both artists and clients were supportive of SSI! Artists are viewed as a trusted source of information and have the potential to impact clients’ sun safety practices. Suggestions regarding training content and format will be incorporated into an online training for tattoo artists.

This research was funded by a grant from the National Cancer Institute (R01CA206569; Dr. Barbara Walkosz, Klein Buendel, Principal Investigator). Collaborators include Dr. David Buller, Mary Buller, Rachel Eye, and Savanna Olivas from Klein Buendel; and Dr. Dellavalle from the University of Colorado, Denver.

Klein Buendel was one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Costs of Sun Safety Policy Implementation in California Elementary Schools

May 3, 2018 Klein Buendel

Dr. Richard Meenan is presenting cost analysis data from the Sun Safe Schools project at the 4^th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focuses on the estimated costs of delivering a sun protection policy intervention to public elementary schools in California.

Implementation of sun safety practices is an important element of efforts by elementary schools to prevent skin cancer among their students. However, cost can significantly impede such implementation. The Sun Safe Schools (SSS) trial provided technical assistance to 118 California public elementary schools interested in implementing sun safety practices consistent with district policy. Intervention components were primarily an initial intervention meeting with school administrators, and follow-up email and telephone communications. Schools chose from 47 possible practices to implement.

Using a micro-costing approach, intervention delivery costs to the intervening organization were determined from the project tracking database supplemented by external sources. Labor and non-labor practice costs incurred by schools were estimated using a project template, which three authors reviewed for reasonableness. The 47 practice codes were collapsed into ten categories, such as outdoor shade and parent outreach. The 58 intervention schools implemented a total of 128 practices. Thirty-seven schools implemented at least one practice. Most common practices were parent outreach, education of students, and teacher training. Data on the average cost of participating in the school-based sun safety intervention will be presented at the conference.

In summary, costs to schools may hinder action on implementation, so cost control strategies should be considered when designing school-based sun safety interventions. Next steps are to determine: (1) the incremental implementation cost of the SSS intervention and (2) the incremental cost of the schools’ sun safety education and policy adoption actions induced by SSS.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (R01HD074416; Dr. Kim Reynolds, Claremont Graduate University, Principal Investigator). Collaborators include Kim Massie from Claremont Graduate University in California; Dr. David Buller, Julia Berteletti, and Mary Buller from Klein Buendel; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; and Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California.

Klein Buendel is one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Sun Safe Schools Program Implementation

April 30, 2018 Klein Buendel

Ms. Kim Massie is presenting a poster on the implementation of the Sun Safe Schools project at the 4^th International Conference on UV and Skin Cancer Prevention in Toronto, Canada, May 1-4, 2018. The poster focuses on the delivery of a sun protection policy intervention to public elementary schools in California.

The U.S. Surgeon General’s Call to Action to Prevent Skin Cancer in 2014 emphasized the importance of sun safety for schools; however, there is limited information on how to effectively assist schools in implementing sun safety. The Sun Safe Schools project was developed to provide technical assistance to 118 public elementary schools in California with the implementation of sun safety practices consistent with district board policy for sun protection (BP 5141.7). A trained coach worked with principals to select sun safety practices within policy categories, such as education of students and parent outreach, and develop their implementation plan. The coach recorded all reported intervention activities within a tracking database including practice selection date, policy category, practice description, and implementation date.

A variety of practices, such as posting the UV Index and providing sunscreen, were implemented at 58 intervention schools. Practices were predominately implemented in the first 12 months of the 20-month program. Most practices were implemented in the spring. Low periods of implementation coincided with summer and winter breaks in the school calendar. The most frequently implemented practices included distributing sun safety information to parents, arranging sun safety presentations for students, and providing a sun safety webinar to staff. Policy categories most frequently implemented included education of students, parent outreach, and education of teachers.

Overall, working with schools presents unique challenges for implementation of sun safety. To be effective, implementation assistance should be designed around the school calendar and allow the principal to determine the pace and priorities.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (R01HD074416; Dr. Kim Reynolds, Claremont Graduate University, Principal Investigator). Collaborators include Kim Massie and Brianne Freeth from Claremont Graduate University in California; Dr. David Buller, Julia Berteletti, and Mary Buller from Klein Buendel; and Dr. Jeff Ashley from Sun Safety for Kids, Inc. in Los Angeles, California.