Effects of an Online Responsible Vendor Training for Recreational Marijuana Stores

Effects of an Online Responsible Vendor Training for Recreational Marijuana Stores

The Train To Tend® responsible marijuana vendor (RMV) training research team recently published results from online RMV training on responsible sales for recreational marijuana store personnel as an abstract for the Annals of Behavioral Medicine. The Train To Tend research team is led by Dr. David Buller from Klein Buendel who would have presented the findings at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

Recreational marijuana regulations have been designed, in part, to ensure that cannabis products are sold only to adults over the age of 21 who provide state-approved identification (ID). The Train to Tend online RMV training was developed with input from state regulators and recreational marijuana store personnel to train store staff. The training consists of five modules with interactive learning elements that cover state laws, ID checking, health effects of marijuana, driving under the influence, refusal of sales to intoxicated customers, and store processes, such as product labeling and tracking.

A sample of 175 recreational marijuana stores in Colorado and Washington were selected for a randomized controlled trial with sales to pseudo-underage customers. Of the 175 stores, 75 were assigned to the control condition (usual and customary training) and the remaining 100 were given the online RMV training. At baseline, sales of marijuana to pseudo-underage buyers were refused at 93% of 349 visits to stores across the two states. After adjusting for store characteristics, there was no difference in change in refusal rates between treatment groups from baseline, to a 3-month posttest, or a 9-month posttest. For the intervention stores, training uptake was not related to refusal rate and nearly all recreational cannabis stores refused sales to young patrons who failed to produce appropriate ID.

This research was funded by a grant from the National Institute on Drug Abuse at the National Institutes of Health (DA038933; Dr. David Buller, Principal Investigator). Co-authors include Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation; Dr. Gary Cutter from the University of Alabama, Birmingham; and Dr. Gill Woodall, Andrew Grayson, Mary Buller, Sierra Svendsen, and Lucia Liu from Klein Buendel.

Mothers’ Support for Laws Restricting Indoor Tanning by Minors

Mothers’ Support for Laws Restricting Indoor Tanning by Minors

The Health Chat research team published some findings related to indoor tanning from their Facebook-delivered cancer risk reduction intervention and randomized trial with mothers and teen daughters as an abstract in the Annals of Behavioral Medicine. The research team would have presented the work at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

Indoor tanning is associated with increased risk for melanoma, especially in young women. Several states restrict indoor tanning by minors or require parental permission. The authors of this abstract hypothesize that mothers’ awareness of state laws related to indoor tanning by youth may reduce their permissiveness for daughters to use tanning facilities.

A total of 777 mothers (and their daughters) from 34 states that do not ban indoor tanning participated in the trial. Less than 20% of mothers (and fewer daughters) accurately reported whether their state has an age restriction or parental permission requirement for minors to indoor tan. More than 50% of the mothers supported banning indoor tanning by minors. However, the mothers reported varying levels of advocacy that they would be willing to demonstrate related to enacting state-level policy to restrict indoor tanning by minors (e.g., sign a petition, contact an elected representative, testify to a state legislative committee). 

The authors conclude that: “Efforts to inform mothers and daughters may be needed to create a norm against indoor tanning, to prevent moms from permitting indoor tanning by daughters, and to build support for further restrictions on minors’ access.”

This research is funded by a grant from the National Cancer Institute (CA192652; Dr. David Buller, Klein Buendel, and Dr. Sherry Pagoto, University of Connecticut, Multiple Principal Investigators). Co-authors include Dr. Katie Baker, Dr. Joel Hillhouse, and Jessica Bibeau from East Tennessee State University; Dr. Kim Henry from Colorado State University; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.

E-Training to Enhance the Care of Aged and Dying Prisoners

E-Training to Enhance the Care of Aged and Dying Prisoners

The health care needs of aged, chronically ill, and dying inmates in correctional settings face growing demands. The Enhancing Care for the Aged and Dying in Prisons (ECAD-P) research team published insights from a geriatric care learning program for corrections staff as an abstract for the Annals of Behavioral Medicine. The ECAD-P research team is led by Dr. Susan Loeb from Penn State University and Dr. Valerie Myers from Klein Buendel. They would have presented the work at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

The number of older inmates in the United States continues to grow and best practices for managing geriatric issues and end-of-life (EOL) care have not been adapted for use in corrections settings. In response, ECAD-P team has developed a computer-based learning program for corrections staff comprised of six modules that address EOL and geriatric care concerns in prisons.

After conducting two rounds of usability testing at two prisons in different states, the ECAD-P program entered full-scale testing at seven state prisons. A total of 241 individuals consented to participate and 173 individuals completed all training modules and posttests. Outcomes revealed that the ECAD-P training program was acceptable, feasible, and usable in the corrections staff setting. The research team also found that corrections staff improved their knowledge of geriatric and EOL care of inmates overall after completing the training.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators and co-authors on this abstract also include Dr. Erin Kitt-Lewis from Penn State University; Dr. Rachel Wion from the Indiana University School of Nursing (formerly Penn State University); Julie Murphy from the King’s College Nursing Program; and Tiffany Jerrod, formerly of Klein Buendel.

Health Misinformation in Participant Comments in a Facebook-Delivered Cancer Risk Reduction Intervention

Health Misinformation in Participant Comments in a Facebook-Delivered Cancer Risk Reduction Intervention

Little is known about how how participants in a health intervention share health misinformation via social media platforms. The Health Chat research team published insights from their Facebook-delivered cancer risk reduction intervention and randomized trial with mothers and teen daughters as an abstract for the Society of Behavioral Medicine (SBM). The lead author, Kelsey Arroyo, from the University of Connecticut, would have presented the work at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

For this study, the researchers examined 175 comments made to 42 randomly-selected Facebook posts on different health topics such as substance use, indoor tanning, vaccines, mental health by study participants. The Facebook groups were moderated by health professionals. The participant comments were coded as sharing an opinion, a personal experience, an intention, or information. Comments were analyzed for whether misinformation was conveyed. According to the authors, “misinformation was defined as a fact, belief, opinion, or action that is not supported by scientific evidence.”

Analysis showed that more than three-quarters of comments shared a personal experience. Overall, less than one-fifth of the comments conveyed misinformation, and more than half of the misinformation was conveyed in comments that shared a personal experience.

This research is funded by a grant from the National Cancer Institute (CA192652; Dr. David Buller, Klein Buendel, and Dr. Sherry Pagoto, University of Connecticut, Multiple Principal Investigators). Collaborators and co-authors on the SBM abstract include Kelsey Arroyo, Jared Goetz, and Dr. Molly Waring from the University of Connecticut; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kim Henry from Colorado State University; Dr. Jerod Stapleton formerly from the Rutgers Cancer Institute of New Jersey; and Julia Berteletti and Dr. Barbara Walkosz from Klein Buendel.

Sun Safety Communication and Behavior for Students in a School Policy Intervention

Sun Safety Communication and Behavior for Students in a School Policy Intervention

In a recent publication in the Australian and New Zealand Journal of Public Health, Klein Buendel researchers and collaborators evaluated the Sun Safe Schools policy implementation intervention program in California school districts.

The United States has a high occurrence of skin cancer which has created a call to action for many organizations. The Sun Safe Schools program was created to help prevent skin cancer and to protect the nation’s youth by encouraging healthy sun safety habits for young students. In schools specifically, “children receive substantial solar ultraviolet radiation (UV) exposure, including while at school (1), and are frequently sunburned (2).”

In the study, primary schools who had existing sun safety policies were randomized into intervention and control groups and a posttest was distributed to parents. With parents in the intervention schools receiving more information about sun safety, their students on average were more likely to wear sun-protective clothing outside of school more frequently than the students of parents in the control schools. Parents in the intervention group also reported less sunburns and less time outdoors among children whose schools had implemented sun safety practices. A full description of the methods, analyses, results, conclusions, and limitations can be found in the publication.

Overall, support and implementation for a sun protection policy in school districts increased the amount of sun safety information to parents and increased the effectiveness of sun safety behaviors for children. However, experienced faculty and engaging parents are both important factors in the prevention of student skin cancer.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds and Dr. David Buller, Multiple Principal Investigators). Other authors include Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Kim Massie previously from Claremont Graduate University; and Mary Buller and Julia Berteletti from Klein Buendel.

References

1. Buller DB, Borland R. Skin cancer prevention for children: a critical review. Health Educ Behav. 1999;26(3):317-43.

2. Buller DB, Cokkinides V, Hall HI, Hartman AM, Saraiya M, Miller E, et al. Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: systematic review from national surveys. J Am Acad Dermatol. 2011;65(5 Suppl 1):114-23.

Supporting Implementation of Sun Safety Policies in Schools

Supporting Implementation of Sun Safety Policies in Schools

Many schools in California are working to increase sun protection practices by students, parents, teachers, and staff in an effort to reduce over-exposure to ultraviolet radiation and prevent skin cancer in the long term. A paper published recently in Preventive Medicine presents the results of a large randomized trial assessing an intervention designed to close a sun safety policy-practice gap in California elementary schools. The trial tested the hypothesis that schools with sun safety policies randomly assigned to receive the Sun Safe Schools intervention would implement more sun safety practices than schools in a minimal information control group.

Research collaborators from Claremont Graduate University, Klein Buendel, the Kaiser Permanente Center for Health Research, and Sun Safety for Kids, Inc. implemented the Sun Safe Schools program in 118 elementary schools from 40 California public school districts. Each school district had a school board-approved policy for sun safety (Board Policy 5141.7). The 20-month intervention was delivered to principals and included a coaching session, telephone and email contacts, resources for implementing sun protection practices, and a small grant program (for example, to purchase sunscreen for students).

The Sun Safe Schools intervention was effective at narrowing the sun safety policy-practice gap in participating California elementary schools. The program increased the total number of sun safety practices implemented by intervention schools compared to control schools. Also, more intervention schools’ sun safety practices reflected elements of district policy and sometimes went beyond the elements included in district policy. Detailed descriptions of the sample, measures, methods, analyses, outcomes, strengths, and limitations of the randomized controlled trial can be found in the Preventive Medicine publication.

The research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (HD074416; Dr. Kim Reynolds, Claremont Graduate University, and Dr. David Buller, Multiple Principal Investigators). Coauthors, in addition to Dr. Reynolds and Dr. Buller, include Kim Massie formerly from CGU; Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; and Julia Berteletti and Mary Buller from Klein Buendel.

Gaining Entry to Correctional Settings for Health Research

Gaining Entry to Correctional Settings for Health Research

In a recent publication for a special issue on Nursing Leadership in Correction in the journal Nursing Leadership, authors from Penn State University, Indiana University, King’s College, and Klein Buendel share lessons learned from implementing a large-scale health communication research project in correctional settings. The NIH-funded project developed, implemented, and evaluated computer-based learning modules to train corrections personnel in geriatric and end-of-life care for incarcerated individuals. The program, Enhancing Care for the Aged and Dying in Prison, 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.

The lessons learned, and described in detail in the publication, include the importance of building a team of experts, “planning and punting” (such as designing a reliable communication plan and adjusting to the distinctive facets of each prison), coordinating with institutional review boards to protect vulnerable populations, and examining denied applications for access to correctional facilities in order to inform future planning. According to the authors, “These lessons serve to establish best practices on how to access correctional settings and to enable more research in corrections.” Access to even one correctional facility can help researchers learn more about and help to improve healthcare for people who are incarcerated.

This research was funded by a Phase I and II STTR grant from the National Institute on Aging (AG049570). The Phase I Multiple Principal Investigators were Dr. Janice Penrod and Dr. Susan Loeb from Penn State University. The Phase II Multiple Principal Investigators were Dr. Susan Loeb and Dr. Valerie Myers from Penn State University and Klein Buendel, respectively.  The first author of the recent Nursing Leadership publication is Dr. Erin Kitt-Lewis from Penn State University. Her coauthors include Dr. Susan Loeb from Penn State University, Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel, Dr. Rachel Wion from Indiana University, and Dr. Julie Murphy from King’s College.

Inmates Care

Inmates Care

Whether one reaches the end of his or her life in a private home, a nursing home, or a correctional facility, the need for quality, compassionate palliative care is universal.

The demographics of the American prison population are shifting at a dramatic rate requiring new approaches to prison healthcare. Current estimates suggest that there are 2.3 million incarcerated persons in the United States (1). Similar to the free world, the aging of the Baby Boom generation is occurring in prisons. Notably, inmates 50 and older constitute over 20% of prisoners in state or federal facilities (2). Many sentenced offenders are living through middle and older adulthood within the confines of prisons (3,4). These trends profoundly impact prison systems that are legally responsible for providing needed care to prisoners along with ensuring their custody and control (5). The health status of aging inmates does not mirror the free world population. Prisoners typically present with health issues common to free citizens who are 10 to 15 years their senior. Collectively, these trends have had a profound impact on prison systems and prisons are facing sharply increased demands in caring for aged and dying inmates.

Dr. Susan Loeb of Penn State University and Dr. Valerie Myers of Klein Buendel (Multiple Principal Investigators) are leading a new research project being awarded to Klein Buendel entitled, E-training of Inmate Peer Caregivers for Enhancing Geriatric and End-of-Life Care in Prisons – the Inmates Care Project. Inmates Care is a computer-based interactive training system designed to provide inmate peer caregivers with training in geriatric and end-of-life (EOL) care. Broadly defined, EOL care is the care provided to persons in their final stages of life; also referred to as hospice care, comfort care, supportive care, palliative care or symptom management (6). The Inmates Care system will provide rigorous, evidence-based best practices through media-rich and highly interactive computer-based learning modules for providing EOL and geriatric care to prison peers. It will function within institutions’ technology and connectivity limitations and be much more engaging and interactive than the educational programs commonly available to those living in prison.

Prisons are facing sharply increased demands in caring for aged and dying inmates (7). Inmates offer an abundant human resource that is poised to contribute in important ways to augment corrections staff in meeting a growing care need in U.S. prisons. This new study will refine and expand the modules that were usability-tested in a previous study and evaluate the full program for its fit with inmate peer caregivers within the restrictive constraints of prison systems. Expanded testing of Inmates Care will establish its effectiveness as a program and will provide critical insights relevant to its dissemination and implementation with correctional facilities.

This Phase II research project is funded by a Small Business Innovation Research (SBIR) grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG057239). Dr. Erin Kitt-Lewis from the Penn State University College of Nursing is a Co-Investigator. The CBL modules will be programmed by the Creative Team at Klein Buendel.

References

1. Sawyer W, Wagner P. Mass incarceration: the whole pie 2019. Prison Policy Initiative. Available at: https://www.prisonpolicy.org/factsheets/pie2019_allimages.pdf. Published 2019 March 19. Accessed August 30, 2019.

2. Bronson J, Carson EA. Prisoners in 2017. Available at: https://www.bjs.gov/content/pub/pdf/p17.pdf. Published 2019 April 25. Accessed August 30, 2019.

3. Palazzolo J. U.S. Prisons Grapple With Aging Population. The Wall Street Journal.

4. Carson EA, Sabol WJ. Aging of the state prison population, 1993-2013. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Special report NCJ 248766. Available at: https://www.bjs.gov/content/pub/pdf/aspp9313.pdf. Published May, 2016. Accessed August 30, 2019.

5. Rold WJ. Thirty years after Estelle v. Gamble: A legal retrospective. Journal of Correctional Health Care. 2008;14(1):11-20.

6. National Institutes of Health. National institutes of health state-of-the-science conference statement on improving end-of-life care. NIH Consensus Development Program. Available at: https://consensus.nih.gov/2004/2004EndOfLifeCareSOS024html.htm. Published 2004. Accessed August 30, 2019.

7. Williams BA, Goodwin JS, Baillargeon J, Ahalt C, Walter LC. Addressing the aging crisis in US criminal justice health care. Journal of the American Geriatrics Society. 2012;60(6):1150-1156

Collaborator Spotlight
Dr. Alberta Kong

Collaborator Spotlight
Dr. Alberta Kong

Dr. Alberta Kong has been collaborating with Dr. W. Gill Woodall from Klein Buendel for several years on research to prevent HPV – the Human Papillomavirus – by encouraging vaccination for adolescent girls and boys. They are currently working together on a four-year research project entitled “Web App Technology for Boys and Parents: Improving HPV Vaccine Uptake.” The project, which is funded by a grant from the National Cancer Institute to Klein Buendel (CA210125; W.G. Woodall, Principal Investigator), is creating and testing a mobile web app to accurately inform parents and adolescent boys about the HPV vaccination and address unique concerns about its safety and effectiveness for boys.

Dr. Kong specializes in adolescent health and infectious disease prevention. She is an Associate Professor with a primary appointment in the Department of Pediatrics, Division of Adolescent Medicine and a secondary appointment in the Department of Family and Community Medicine at the University of New Mexico (UNM) Health Sciences Center. She received her Medical Degree from the University of Arizona. Dr. Kong is one of only two Board Certified Adolescent Medicine Specialists in the state of New Mexico. In addition to practicing medicine, she teaches and mentors medical students, pediatric residents, graduate students, and junior faculty members.

According to her UNM bio, “Dr. Kong’s research interests relate to highly prevalent conditions such as sexually-transmitted infections and obesity that commonly affect adolescents. Her research ranges from observational studies to development and testing of interventions targeting behavior change to improve adolescent health outcomes. Regardless of the research design, she utilizes community engagement approaches to ensure that her research has real world applications that can contribute to clinical care of the population she serves.”

Among other research projects, Dr. Kong is the Principal Investigator on a study funded by the National Institutes of Health, National Heart Lung and Blood Institute (HL118734) investigating the efficacy of motivational interviewing approaches for overweight and obesity prevention and treatment through the use of school-based health centers.

Lessons Learned: Accessing Sites for Correctional Research

Lessons Learned: Accessing Sites for Correctional Research

Dr. Erin Kitt-Lewis from Penn State University presented insights into accessing correctional facilities for research at the 32nd Annual Scientific Sessions virtual conference of the Eastern Nursing Research Society on March 26-27, 2020. Klein Buendel Senior Scientist, Dr. Valerie Myers, was a co-author on the presentation.

Despite the imperative to engage in research in corrections, researchers face many challenges due to the restrictive nature of this setting. Dr. Kitt-Lewis shared many of the lessons learned by this collaborative research team as they worked to secure diverse prison and jail settings to research, develop, and test the Enhancing Care for the Aged and Dying in Prison program.

Lessons learned included the discovery of contextually-specific constraints such as the closing or consolidating of services or facilities, managing staffing constraints, relocating staff, ascertaining and adhering to policies and administrative directives, and working within the guidelines of the review board of the correctional system.

Establishing and maintaining relationships with key stakeholders in corrections were also important aspects of this research. In her presentation, Dr. Kitt-Lewis discussed developing networking opportunities such as connecting via social media like LinkedIn, attending corrections conferences, and discussing potential research opportunities to help build relationships with key stakeholders and decision-makers. Additional perceptions from the field included identifying potential barriers or constraints to accessing correctional sites, and sustaining relationships post-research via ongoing communication such as sharing periodic updates, final reports, and publications with partners.

The correctional system has often been called a “closed” system due to the difficulty faced by researchers in attempting to access and conduct research. However, establishing well-defined strategies to conduct research in the system appears to create efficiency and promote much needed health-related research in the correction setting. Research outcomes that are contextually-specific can support and foster equitable care for people who are incarcerated.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the work presented, in addition to Dr. Erin Kitt-Lewis, include Dr. Susan Loeb and Kaléi Kowalchik from Penn State University; Dr. Rachel Wion from Indiana University School of Nursing; Julie Murphy from King College Nursing Program; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.