Refusal of Pseudo-intoxicated Customers at Retail Marijuana Stores

Refusal of Pseudo-intoxicated Customers at Retail Marijuana Stores

Klein Buendel Senior Scientist, Dr. David Buller presented a poster at the Society for Prevention Research Annual Meeting in San Francisco, California in May. The poster presented insights on whether personnel in recreational marijuana stores refuse sales to buyers who appear to be intoxicated.

Recreational marijuana is sold by state-licensed stores in seven U.S. states. Like alcohol, sales are prohibited to persons younger than age 21 and sometimes to persons who are apparently intoxicated. A sample of 150 licensed retail stores in Colorado, Oregon, and Washington were selected from state regulatory agency lists. A majority of stores sold both recreational and medical marijuana. The sample was stratified between the largest metropolitan area in each state (Denver, Portland, and Seattle) and nearby regions with smaller cities.

Pseudo-patron assessment teams comprised of a ‘buyer’ and an ‘observer’, visited each store once from August to October 2018. Buyers attempted to enter the premises while feigning obvious signs of intoxication (for example: slurred speech, stumbling, dropped change or ID) and attempted to purchase a low-cost cannabis product. Observers recorded whether buyers gained entry and if the clerk offered to sell marijuana (no actual purchases were made).

Refusal rates were rare. Overall, refusal rates were slightly higher in the states of Colorado and Oregon than in Washington. A state law that explicitly prohibited sales in Oregon may have slightly decreased sales there, while refusals in Colorado may be attributed to the wide-scale use of security guards checking IDs at entrances. These high rates of sales to apparently intoxicated customers are a cause for concern, especially in light of research indicating that the combination of alcohol and marijuana intoxication appears to severely impair driver performance.

This research project is funded by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Additional collaborators include Dr. Robert Saltz from the Pacific Institute for Research and Evaluation in Oakland, California; and Dr. Gill Woodall and Andrew Grayson from Klein Buendel.

Nightlife Risk from Alcohol and Drug Use

Nightlife Risk from Alcohol and Drug Use

Two Klein Buendel researchers are part of a team that presented two posters at the Society for Prevention Research Annual Meeting in San Francisco in May. Dr. David Buller and Julia Berteletti are part of the Nightlife Safety Plans research team led by Dr. Brenda Miller from the Prevention Research Center at the Pacific Institute for Research and Evaluation (PIRE).

Nightclubs are high-risk settings for overuse of alcohol and other drugs and physical and sexual aggression among young adults. Nightlife Safety Plans (NSP) is a group-based, tablet app-delivered intervention designed for patrons arriving together. NSP addresses these unwanted outcomes and encourages social groups to recognize early indicators of risk. Actions steps are provided via tablet app to de-escalate the situation. 

Nightclub Group Gender Composition

The first poster examined the influence of social group gender composition on alcohol outcomes and on the effectiveness of the NSP intervention across different group compositions (all-female, all-male, mixed gender). The sample included 959 nightclub patrons who formed 359 groups recruited from seven clubs, across 41 different events. Less than half of the participants were female and the average age was 26. All data was collected anonymously.

Outcome variables included overall number of the group’s safety actions taken to keep group members safe, the highest number of safety actions by any single group member, and breath alcohol concentration (BAC) at exit.  Mixed model regressions examined the main effect of group composition and its interaction with the intervention as a predictor of outcomes after controlling for individual and group characteristics. Those in the intervention condition reported higher numbers of safety actions by any single member in all female groups and mixed gender groups, but not in all-male groups. There were no significant interactions for intervention status by group composition for either BAC at exit or the number of group actions taken as assessed by the overall group.  This poster was first-authored and presented by Dr. Brenda Miller from PIRE.

Drinking Group Cohesion

The second poster examined the hypothesis that club patrons who perceive greater cohesion in their group implement fewer protective strategies and use higher levels of alcohol and other drugs. Could being part of a more cohesive peer drinking group lead to a false sense of security and letting down one’s guard, which could lead to more risk taking? The sample included 815 nightclub patrons in the San Francisco area, arriving in 324 distinct groups, from seven clubs hosting electronic music dance events across 30 different evenings. Less than half of the participants were female and the average age was 27. Club patrons were surveyed anonymously and completed breath tests as they entered and exited clubs. Oral fluid samples at exit assessed drug use.

Patrons reported perceived cohesion with their group members (for example, people in the group are willing to help each other), as well as use of actions to keep oneself safe, actions to keep group members safe, and actions in response to group alcohol and other drug problems. Mixed model regressions examined group cohesion as a predictor after controlling for individual and group characteristics, and past 30-day drinking/drug use at clubs. Findings partially confirm the hypothesis. Patrons who perceived greater group cohesion engaged in fewer preventive strategies to keep themselves and their group safe during the night and those who perceived greater group cohesion implemented fewer actions in response to group AOD problems. This poster was first-authored and presented by Dr. Hilary Byrnes from PIRE.

The NSP research is funded by a grant to the Prevention Research Center at PIRE from the National Institute on Alcohol Abuse and Alcoholism (AA022331; Dr. Brenda Miller, Principal Investigator). Research team collaborators/authors include Dr. Brenda Miller, Dr. Hilary Byrnes, Dr. Joel Grube, and Dr. Beth Bourdeau, Dr. Mark Johnson, and Veronica Rogers from PIRE; and Dr. David Buller and Julia Berteletti from Klein Buendel. The NSP tablet app was developed by Klein Buendel’s Creative Team.

Collaborator Spotlight:
Dr. Robert Newton

Collaborator Spotlight:
Dr. Robert Newton

Robert Newton, Jr., Ph.D., is an Associate Professor in the Physical Activity and Ethnic Minority Health Laboratory at Pennington Biomedical Research Center (PBRC) at Louisiana State University. He has collaborated with Dr. Valerie Myers for several years – most recently on the Healthy Detours project funded by the U.S. Centers for Disease Control and Prevention and the MobileMen project funded by the National Institute on Minority Health and Health Disparities.

In Phase I of the MobileMen project, a prototype mobile app to track physical activity, tailored to African American men ages 18 to 45, was developed. The goal was to help African American men in the maintenance phase of physical activity to remain actively physically active. Currently, Dr. Newton and Dr. Myers are working on funding for Phase II of MobileMen. In Phase II, all features of the full mobile app will be programmed and evaluated with the target population.

More broadly, Dr. Newton’s research addresses health disparities experienced by the African American community. Much of his work addresses the design and development of physical activity interventions and he also conducts weight loss research. He develops community-based and technologically-driven interventions to promote physical activity, weight management, and weight loss among African American adolescents, adults, and older adults.

Currently, Dr. Newton leads studies assessing the effect of a community-based physical activity intervention in older African American adults and a mobile phone-based intervention targeting increased physical activity in young children. He is also involved in two primary care weight management programs and several childhood physical activity and/or weight management studies.

Dr. Newton has a Ph.D. in Clinical Psychology from the University of Florida. Outside of his work at PBRC, Dr. Newton is the Healthy Equity Special Interest Group Chair for the Society of Behavioral Medicine and is a member of the American College of Sports Medicine.

Prevention of Alcohol Use in Older Teens

Prevention of Alcohol Use in Older Teens

The growing incidence of alcohol use among teens is an important public health problem. In a recent publication in Psychology of Addictive Behaviors, Klein Buendel Senior Scientists, Dr. David Buller and Dr. Gill Woodall, joined multiple co-authors to report on the effects of a new alcohol use prevention program for older teenagers. The program is called Smart Choices 4 Teens. The paper reports the results from a randomized controlled trial assessing the impact of this online, interactive, family-based alcohol prevention program with over 400 families on preventing and reducing teen alcohol use.

Smart Choices 4 Teens was designed with three sequential components: general parent-teen communication, teen alcohol use, and teen romantic relationships. The creators adapted two evidence-based programs — Family Matter (1) and Parent Handbook (2) — to appeal to older teens and their parents. Communication skills training was incorporated through videos and interactive activities. The program was designed to have parents and teens go through the online activities separately and then complete a discussion activity together at the end of each component. The Alcohol Component is the focus of this publication.

Use of the program varied across families and components. Families that used more of the program reported better outcomes. Data related to dosage of the program and changes in drinking rates are reported in detail in the paper. Many positive effects were seen at 6-month and 12-month follow-ups with participating families. For example, teens in the experimental group reported fewer friends who had been drunk at six months, and parents in the experimental group reported more communication about social host laws. At 12 months, parents in the experimental group reported consuming fewer alcoholic beverages.

Overall, the findings suggest that Smart Choices 4 Teens was beneficial for families, especially when parents and teens completed more of the program. The authors believe that dissemination and implementation strategies that motivate completion of Smart Choice 4 Teens content, especially the Alcohol Component, can improve outcomes related to older teens’ alcohol use.

A full description of the methods, results, and conclusions of this study can be found in Psychology of Addictive Behaviors. This research was funded by a grant to the Prevention Research Center at the Pacific Institute for Research and Evaluation from the National Institute on Alcohol Abuse and Alcoholism (AA020977; Brenda Miller, Principal Investigator). Authors in addition to Dr. Miller, Dr. Buller, and Dr. Woodall include first author Dr. Hilary Byrnes, Dr. Joel Grube, Dr. Beth Bourdeau, and Dr. Meme Wang-Schweig from the Pacific Institute for Research and Evaluation. The Smart Choices 4 Teens program was produced by Klein Buendel’s Creative Team.


  1. Bauman, K. E., Foshee, V. A., Ennett, S. T., Hicks, K., & Pemberton, M. (2001). Family Matters: A family-directed program designed to prevent adolescent tobacco and alcohol use. Health Promotion Practice, 2, 81-96.
  2. Turrisi, R., Jaccard, J., Taki, R., Dunnam, H., & Grimes, J. (2001). Examination of the short-term efficacy of a parent intervention to reduce college student drinking tendencies. Psychology of Addictive Behaviors, 15, 366–372.
Sun Safety Ink! Expands to the Latino Community

Sun Safety Ink! Expands to the Latino Community

Skin cancer rates continue to rise in the Hispanic population. In the last two decades, their annual melanoma incidence has increased by 20% (5). Even though Hispanics are diagnosed at a disproportionately lower level than non-Hispanic whites (NHWs), they are diagnosed with melanoma at a younger age, with a more advanced stage of the disease, and have lower melanoma-specific survival rates than NHWs (1,3).

Klein Buendel’s randomized controlled trial, Sun Safety Ink!, trains tattoo artists to offer skin cancer prevention advice to their clients. A recent diversity supplement will extend the Sun Safety Ink! study by focusing on how this information can be targeted to Hispanic tattoo artists and their clients, especially young adults. The supplement’s goals are to discover new approaches to address the increasing rates of skin cancer in the Hispanic population and to provide insight into the implementation of skin cancer prevention in an often hard-to-reach population.

Over 30% of the Hispanic population has tattoos (4), a rate that is higher than NHWs (25%). Tattoo studios, because they often recommend sun protection in their aftercare instructions, are a unique context in which to promote full body sun protection to Latinos. Sun Safety Ink! will distribute sun safety information to hard-to-reach Hispanic young adults. The diversification of the study sample will provide information on (1) baseline knowledge on sun protection in the Latino population, (2) barriers to sun protection, and (3) at-risk populations.

The supplement includes both formative research and the implementation of the Sun Safety Ink! program. Specifically, tattoo studios with Hispanic artists and clients in Utah, Colorado, Arizona, and New Mexico will be recruited to participate in the study. The tattoo artists will be provided with a version of the Sun Safety Ink! training modified based on formative research conducted by Cristian Gonzalez, MD. Dr. Gonzalez is a Research Fellow at the University of Colorado Anschutz Medical Campus and an upcoming Medical Resident at the University of Texas Southwestern Medical Center.

Dr. Gonzalez explained that the most important aspect of this project is that “Latinos have this invincibility factor that they think they can’t get skin cancer because they don’t know a lot of family members or friends with skin cancer, so sometimes it really doesn’t come up. If we can increase awareness of skin cancer in the Latino community, and if we can also improve sun protection behavior, I think we would see a reduction in melanoma and non-melanoma skin cancer in the future.”

Sun Safety Ink! is funded by a grant and a supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz, Principal Investigator). Collaborators include Dr. David Buller, Mary Buller, Rachel Eye, and Savanna Olivas from Klein Buendel; and Dr. Robert Dellavalle from the University of Colorado, Denver.

Dr. Cristian Gonzalez


  1. Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Natale-Pereira A, Goydos JS. Sun protection and exposure behaviors among Hispanic adults in the United States: differences according to acculturation and among Hispanic subgroups. BMC Public Health. 2012;12:985.
  2. Hay J, Coups EJ, Ford J, DiBonaventura M. Exposure to mass media health information, skin cancer beliefs, and sun protection behaviors in a United States probability sample. Journal of the American Academy of Dermatology. 2009;61(5):783-792. doi: 10.1016/j.jaad.2009.04.023.PMC2854488
  3. Harvey VM, Oldfield CW, Chen JT, Eschbach K. Melanoma disparities among US Hispanics: use of the social ecological model to contextualize reasons for inequitable outcomes and frame a research agenda. Journal of Skin Cancer. 2016;2016:4635740. doi: 10.1155/2016/4635740
  4. One in five U.S. adults now has a tattoo [press release]. New York, NY: Harris Insights & Analytics, February 23. Available at:
  5. Skin cancer rates soar in US Hispanics. Sun & Skin News. November 21, 2013;30(4).
Use of Media and Social Media in the Prevention of Substance Use

Use of Media and Social Media in the Prevention of Substance Use

Three Klein Buendel Senior Scientists have authored a chapter in a new 2019 book, Prevention of Substance Use, published by Springer. The chapter titled, “Use of Media and Social Media in the Prevention of Substance Use,” was written by Dr. David Buller, Dr. Barbara Walkosz, and Dr. W. Gill Woodall.

Mass media have changed dramatically over the past 25 years, yet still remain an important channel for substance abuse prevention messages (e.g., alcohol, tobacco, marijuana). Exposure to messaging is an important issue for campaigns. This book chapter describes how online and social media have added new media platforms for substance abuse campaigns. Overall, evaluations of web-based interventions show some promise for substance abuse prevention, although the effects appear modest. Less is known about the effectiveness of social media in substance abuse campaigns, especially the influence of user-generated content and commercial advertising.

The chapter describes several recent changes that have revolutionized the media. These include the birth of the Internet, the emergence of new media (including web-based intervention and social media) that has made content available on-demand, and the introduction of mobile computing that has vastly changed connectivity, reach, and engagement. Each of these developments raises questions (which the authors explore) about the influence of new media on substance abuse campaigns and challenges for conducting research on the effects of prevention intervention delivery. The book chapter delves into the role of audience activity, starting with audience exposure determined by selective attention, exposure, and retention, and moving on to examine user-generated content in the new media environment.

The emergence of new media holds promise for future substance abuse prevention campaigns but comes with a number of challenges that are explored in the chapter. These include (1) the fact that theories of social media impact are not well developed; (2) the development of effective methodologies to measure and assess the effects of emerging media; (3) the determination of how commercial online marketing strategies influence substance use and how social marketing approaches can use similar strategies for prevention; (4) the need to understand the use of multiple platforms for promotion (e.g., broadcast, print, online media); (5) the determination of how best to leverage and encourage user-generated media for substance abuse interventions; and (6) the need to explore the interactive nature of emerging media more fully. The authors suggest that these challenges represent tremendous opportunites to better understand and more effectively impact many different populations for the improvement of their health.

Book Citation

Z. Sloboda, R. Hingson, and H. Petras (Eds.), Prevention of substance use. New York: Springer, 2019.

May is Skin Cancer Awareness Month

May is Skin Cancer Awareness Month

Skin cancer is the most common type of cancer in the United States. Ultraviolet (UV) radiation from the sun is the main cause of skin cancer. UV radiation can also come from tanning booths or sunlamps. The most dangerous kind of skin cancer is called melanoma.

The good news? Skin cancer can almost always be cured when it’s found and treated early – and that includes melanoma.

Here are some helpful resources for information, graphics, and materials to raise awareness about skin cancer and help people take action to prevent or detect it early when it is easier to treat.

American Academy of Dermatology (AAD)

Centers for Disease Control and Prevention (CDC) Skin Cancer Prevention

Skin Cancer Foundation

Real Health Photos

Use Real Health Photos® for improving the impact of health messages for Skin Cancer Awareness Month. The stock photography website includes numerous images of diverse people being sun safe with hats, sunglasses, shade, and sunscreen. Real Health Photos images show diversity of gender, race, ethnicity, age, income level, and health condition.

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.

Klein Buendel Opens a Second Location

Klein Buendel Opens a Second Location

Klein Buendel is pleased to announce the opening of its first satellite location in New Mexico. The new Albuquerque office will house Klein Buendel Senior Scientist Dr. Gill Woodall and a small staff, to conduct multiple health communication and behavior research projects with people in New Mexico and Texas.

The Vacteens project aims to raise the public health profile of human papillomavirus (HPV), increase the need for responsible health services, and examine the cost-effectiveness of risk-based screening to pave the way for the development of new strategies for the prevention of HPV-induced cancers. The objectives of the project are to develop and evaluate a mobile web app to encourage HPV vaccination in New Mexico, an ethnically-diverse state. Current ongoing randomized controlled efficacy trials with parents and their adolescent children in New Mexico clinics provide data to determine the impact of these mobile web apps on informed decision making and uptake for the HPV vaccine. This research was funded by a grant from the National Cancer Institute (CA210125; Dr. W. Gill Woodall, Principal Investigator). Collaborators include Dr. Alberta Kong, Dr. Lance Chilton, and Dr. Tamar Ginossar from the University of New Mexico; Dr. Greg Zimet from Indiana University; and Dr. David Buller from Klein Buendel.

B-SMART is a project aimed at reducing intoxicated driving by people with court-ordered ignition interlock devices (IIDs) through improved communication and support from family members. Using smartphone web app technology, B-SMART teaches coping skills, communication skills, and strategies to help deter Driving While Impaired (DWI). Unique to this intervention are the involvement of family members in supporting the DWI offender to not drink and drive, English and Spanish language options, and the use of smartphone technology to make that support immediate, accessible, and diffusible. The research is funded by the National Institute on Alcohol Abuse and Alcoholism (AA022850; Dr. W. Gill Woodall, Principal Investigator) through the Small Business Innovation Research Program (SBIR). Collaborators include Dr. Barbara McCrady and Dr. Vern Westerberg from the University of New Mexico; Dr. Gary Cutter from Pythagorus, Inc. in Alabama; and Julia Berteletti from Klein Buendel.

WayToServe Espanol: A Culturally-Appropriate Online Responsible Beverage Service Training for Spanish-Speaking Servers is a redesign of WayToServe®, an evidence-based training to promote responsible alcohol beverage service (RBS). WayToServe Espanol was created after discovering current RBS training had not been tailored to address Spanish-speaking populations that represent disproportionately high rates of alcohol-related injury and death in the United States. This project promotes a culturally and linguistically adapted RBS training for Spanish-speaking servers, and changes to organizational and community norms because preventing alcohol-related injury and death is a national priority. This research is funded by the National Institute of Minority Health and Health Disparities at the National Institutes of Health (MD010405; Dr. Gill Woodall, Principal Investigator) through the SBIR. Collaborators include Dr. Victoria Sanchez from the University of New Mexico Health Sciences Center; and Dr. Areli Chacon Silva and Dr. Frank Perez from the University of Texas at El Paso.

Insights About HPV Vaccination in the United States from Mothers on Facebook

Insights About HPV Vaccination in the United States from Mothers on Facebook

According to the Centers for Disease Control and Prevention, the most common sexually transmitted infection is the human papillomavirus (HPV) but only about half of girls and less than 40% of boys in the United States have received all the recommended doses of the HPV vaccine (1). In a recent e-publication in Human Vaccines and Immunotherapeutics, Klein Buendel Senior Scientists, Dr. David Buller and Barbara Walkosz, and Project Manager, Julia Berteletti, and coauthors provide insights on HPV vaccination in the United States from mothers’ comments on Facebook posts in a randomized trial. The study evaluated responses from mothers of teenage girls living in various U.S. states in relation to HPV vaccine health and related information posted to private groups on Facebook.

A large number of mothers of 14-17-year-old girls joined private groups on Facebook where a variety of health information relevant to adolescent girls was posted daily. Topics included indoor tanning, mother-daughter communication, and HPV vaccinations. Posts discussing HPV vaccination were posted in each of the groups and ranged from didactic messages (e.g., the need for adolescent vaccines, how well HPV vaccines are working to decrease infection rate, number of parents choosing to vaccinate children against HPV, etc.) to narrative posts about women who have died from cervical cancer. Posts also included a link to an article, video, photograph, or an infographic.

Comments by participants were generally more favorable toward HPV vaccination than unfavorable. Mothers’ comments are further described in the journal article.

A strength of the analyses identifying participant pre-existing characteristics before posting the HPV messages on Facebook, therefore being able to show that HPV vaccination was a predictor of commenting behavior with mothers who had not vaccinated their daughters as the unfavorable commenters. It is noted that many of the mothers who did not comment had daughters that were vaccinated for HPV. A possible weakness of the study was that the sample of mothers may have limited generalizability. Authors conclude by stating that the fact that many mothers who had daughters vaccinated against HPV did not comment on the HPV posts could contribute to the idea that opposition to the HPV vaccine is larger than it is in actuality. Authors also suggest that U.S. public health agencies and practitioners need to find ways to dispel myths and provide information on vaccine safety and concerns, including that many mothers choose to vaccinate their daughters against HPV.

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


  1. Sexually transmitted disease surveillance 2017: other STDs. Centers for Disease Control and Prevention Web site. Available at: Accessed March 28, 2019.
Inmate Caregiver Training in Geriatrics and End-Of-Life

Inmate Caregiver Training in Geriatrics and End-Of-Life

Dr. Susan Loeb from Penn State University presented on the development of computer-based learning modules for caregivers of the aged and dying in prisons at the 31st Annual Scientific Sessions of the Eastern Nursing Research Society (ENRS) held in Providence, RI on April 3-5, 2019. This research is being conducted with Klein Buendel Senior Scientist, Dr. Valerie Myers, a co-author on the presentation.

More men and women are aging and facing end-of-life (EOL) while incarcerated. Early research by this research team found that computer-based training for inmates assisting staff in geriatric and EOL care was feasible. This collaborative team of nurse scientists, small business partners, and the correctional community are working to advance the quality of care provided for those aging and dying in our nations’ correctional institutions. Specifically, the purpose of the research presented at ENRS was to identify inmate peer caregiver training needs, and discover priority content areas and core values for inmate computer-based modules with the help of stakeholders and experts.

Six focus groups were conducted with stakeholders at one men’s and one women’s state correctional institution in a Mid-Atlantic state. Stakeholders included information technology and human resources staff, interdisciplinary front line staff who oversee inmate peer caregivers, and inmate peer caregivers. A content analysis identified content areas and core values. An Advisory Board of experts in EOL and geriatric care, corrections health, and corrections training, suggested combining some of the priority content areas. The resulting priority content areas for the initial Inmates Care modules were Universal Precautions, Role of the Inmate Caregiver in the Final Hours, and Loss and Grief. The core values identified for the inmates training were respect, dignity, and compassion. The next steps of the research project include completing three prototype modules, testing them for usability, and developing a specifications document for technology programming and production congruent with correctional facility security precautions.

This research was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG057239; Dr. Susan Loeb, Principal Investigator) and Dr. Valerie Myers, Co-Investigator. Additional collaborators on the work presented at the conference include Dr. Erin Kitt-Lewis, Dr. Rachel Wion, and Julie Murphy from the Penn State University College of Nursing, and Tiffany Jerrod and Morgan Carter from Klein Buendel. The technology-based modules are being developed by the Creative Team at Klein Buendel.