Cancer Prevention Research Presented at ASPO

Cancer Prevention Research Presented at ASPO

Klein Buendel investigators and their collaborators presented research from two large studies at the 50th Annual Meeting of the American Society of Preventive Oncology on April 12-14 in Denver, Colorado. The theme of the conference was “50 Years of Impact: Empowering Communities Through Cancer Prevention Research.” 

*Klein Buendel authors are bolded.

ORAL PRESENTATION 1

Title: A Confederate Study of Indoor Tanning Facility Compliance with Laws

Presenter: Dr. Carolyn Heckman

Co-authors: Anna Mitarotondo, Melissa Goldstein, Rucha Janodia, Ileana Gonzalez, Dr. David Buller, Julia Berteletti

  • This submission was designated as a Best of ASPO Abstract.

Because indoor tanning is a known cause of skin cancer, state laws and federal regulations restricting indoor tanning for minors have been implemented: 22 states and the District of Columbia (DC) ban minors under age 18 from indoor tanning, 22 states have other age and parental involvement restrictions, and 6 states have no restrictions on minor access to indoor tanning. The assessed indoor tanning facility law compliance, hypothesized to be insufficient and inconsistent.

Trained and supervised pseudo-patrons called randomly selected indoor tanning facilities (indoor tanning salons, beauty salons/spas, gyms, apartment buildings) in 50 states and DC, posing as minors one year younger than the state’s permitted age to indoor tan (age 17 in states banning indoor tanning under 18) or age 16 in states with no age restriction. Using a semi-structured script, pseudo-patrons asked about scheduling an indoor tanning session, unlimited indoor tanning (contrary to FDA guidelines), risk of skin burns, and parental involvement requirements. Responses were coded, with discrepancies resolved by consensus, and summarized descriptively.

A total of 504 calls were completed to 206 indoor tanning salons, 111 gyms, 101 spas/beauty salons, and 86 apartment buildings. Overall, 55% of facilities would allow pseudo-patrons to book an appointment or “walk in” for indoor tanning, despite being underage, compared to 32% in states with under-18 bans. In states with minor restrictions, indoor tanning salons were least likely (48%) to permit minor indoor tanning and gyms, most likely to do so (56%). Twenty-six percent (26%) of staff did not ask pseudo-patrons their age, irrespective of law type. Forty-four percent (44%) of gyms/apartments did not require membership/tenancy to indoor tan. Most facilities (92%) offered unlimited indoor tanning packages or unlimited access to tanning beds when open. Only 52% of facility staff acknowledged that pseudo-patrons’ skin could be burned, when asked.

Although many states have laws restricting indoor tanning by minors, indoor tanning facilities were commonly non-compliant with age restrictions, suggesting inadequate law awareness and/or enforcement. Strategies must be identified to implement indoor tanning laws effectively and realize their benefits, including preventing skin burns, skin cancer, and other health consequences. Ongoing analyses are evaluating compliance when scheduling appointments online and by additional law provisions, state demographics, and U.S. region.

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).

POSTER 1 

Title: Correlates of Human Papillomavirus Vaccination Among a Sample of Emerging Adults Aged 18-26 Living in Rural Locations in the Western United States

Presenter: Dr. David Buller

Co-authors:  Dr. Deanna Kepka, Dr. Echo Warner, Dr. Evelinn Borrayo, Dr. Andrew Sussman, Alishia Kinsey, Dr. W. Gill Woodall, Dr. David Buller

Dr. Borrayo, Dr. Buller and Dr. Warner

Human Papillomavirus (HPV) vaccination status and correlates were examined in a sample of emerging adults living in rural locations in the western United States. Eight hundred and ten (n=810) emerging adults residing in rural areas in 17 western U.S. states were recruited from online survey panels or by social media advertising from August 2024-2025 for a randomized trial. Emerging adults reported at baseline their HPV vaccine uptake status, including number of doses received. Using logistic regression analysis, we tested the association of demographics, attitudes, health care, and social media use with HPV vaccine uptake status (0=no/don’t know; 1=vaccinated) and vaccine doses received (0=0 or 1 dose/don’t know; 1=2 or 3 doses).

Overall, 424 (52.3%) rural emerging adults reported being vaccinated for HPV and 184 (22.7%) not being vaccinated, and 202 (24.9%) did not know. Of the 424 emerging adults vaccinated, 41 emerging adults (9.7%) recalled receiving one dose, 88 (20.7%) two doses, and 101 (23.8%) three doses of the vaccine, but 194 emerging adults (45.8%) did not know. More rural emerging adults who were vaccinated were female, more educated, attended religious services less frequently, had a personal/family history of cancer, were more confident vaccines are safe, and had less constraints on getting vaccinated. More rural emerging adults with multiple vaccine doses were older, female, visited a physician for a routine health check-up more recently, were more confident that vaccines are safe, and had less constraints on getting vaccinated.

Uptake of HPV vaccination among rural emerging adults (52.3%) was slightly higher than the national rate in the 2022 National Health Interview Survey (47.4%). Emerging adults need advice on how to confirm vaccination status (such as checking with parent, physician, or vaccine registry) when promoting catch-up HPV vaccination. HPV vaccination interventions should educate on vaccine safety/ constraints, how it can reduce personal/family cancer concerns, and religious groups that support it. Medical providers should offer HPV vaccination to emerging adults during routine health check-ups. Male and less educated emerging adults would benefit from intervention.

This research from the #4Corners4Health study was supported by a grant to Klein Buendel from the National Cancer Institute (CA268037; Dr. David Buller and Dr. Andrew Sussman, Multiple Principal Investigators). Other collaborators are from the University of Arizona, the University of Colorado, the University of Utah, and Colorado State University.

POSTER 2 

Title: Associations Between Food Insecurity and Dietary Intake and Nicotine Use Among Rural Emerging Adults in the Western United States

Presenter: Dr. Megan Skiba

Co-authors:  Dr. Doug Taren, Dr. Dolores Guest, Dr. Kim Henry, Dr. Judith Gordon, Noah Chirico, Dr. Echo Warner, Alishia Kinsey, Angela Jung, Dr. Andrew Sussman, Dr. David Buller

Dr. Skiba

The purpose of the study was to evaluate the associations between food insecurity, dietary intake, and tobacco/nicotine use among emerging adults aged 18-26 years living in rural areas of the western United States. 

This analysis used baseline data from 810 rural emerging adults participating in a randomized trial evaluating a social media-delivered cancer prevention intervention. Emerging adults completed self-report surveys assessing demographics, dietary intake (NCI Dietary Screener Questionnaire), and any nicotine product use (yes/no) in the past 30 days. Dietary measures included predicted intake of fruit and vegetable (servings/day), fiber (g/day), added sugar from sugar sweetened beverages (tsp/day), and red/processed meat (frequency/week). Food insecurity was categorized as very low food secure, low food secure, and high food secure from a single item measuring worry about running out of food before having money to buy more. Associations between food insecurity and dietary intake or tobacco/nicotine use were examined using linear or logistic regression models, adjusting for significant demographic covariates. Linear trend tests assessed graded relationships across food insecurity levels.

Of emerging adults (mean age 22.7 years), 62% reported low or very low food security. Food insecurity was associated with race, sex, education, and employment and were used as model covariates. A positive linear trend was observed between food insecurity and added sugar from sugar sweetened beverages, with very low food secure emerging adults consuming an average of 13.0 tsp/day from sugar sweetened beverages. There were no significant associations between food insecurity and fruit and vegetable, fiber, or red/processed meat intake, although fruit and vegetable and fiber intake were low overall (2.3 ± 0.6 servings/day and 15.1 ± 3.4 g/day, respectively). Percent of emerging adults using nicotine was greater with increasing levels of food insecurity: 24% among those with high food security, 41% among those with low food security, and 53% among those with very low food security. Odds increased 2.5 times for each stepwise increase in food insecurity.

Experiencing food insecurity may be a determinant of cancer-preventive health behaviors in rural emerging adults. Very low food security may be an important target for interventions aimed at improving multiple cancer preventive health behaviors among rural emerging adults.

This research from the #4Corners4Health study was supported by a grant to Klein Buendel from the National Cancer Institute (CA268037; Dr. David Buller and Dr. Andrew Sussman, Multiple Principal Investigators). Other collaborators are from the University of Arizona, the University of Colorado, the University of Utah, and Colorado State University.

Noncompliance with laws to prevent polysubstance misuse

Noncompliance with laws to prevent polysubstance misuse

The effectiveness of statutes to combat hazardous polysubstance use (for example, alcohol and cannabis together) has rarely been evaluated. A multi-institutional team led by Klein Buendel researchers assessed compliance with a state law prohibiting recreational cannabis sales to apparently intoxicated customers in one of the first states to legalize cannabis sales. The assessment has been published in Alcohol: Clinical and Experimental Research.

In January to June 2024, pseudo-patrons visited 189 recreational cannabis stores twice in two large metropolitan areas and attempted to purchase cannabis while displaying alcohol intoxication behaviors. Observers recorded whether sellers were willing to sell the product along with characteristics of the stores (busyness, cleanliness, and signage) and cannabis sellers (sex, race and ethnicity, and age). Neighborhood characteristics by U.S. census tract were obtained (income, race, and ethnicity; population density). Sex and race and ethnicity of the pseudo-patrons, and extent and type of intoxication cues, were recorded. Descriptive statistics and logistic regression were used to describe the sales rate and predictors of the sales rate.

Assessments were completed at 173 stores. Sellers were willing to sell cannabis to pseudo-intoxicated buyers at 255 of 346 visits (73.7%). Sellers refused buyers at both visits in 6.9% of stores but in 54.3% were willing to sell at both visits. Sellers refused cannabis sales at higher rates in stores with signs saying, “no sales to intoxicated customers” (34.3%), particularly when buyers displayed more obvious signs of intoxication (39.8%).

Low compliance with the state regulation possibly occurred because sellers were unaware of the law, perceived little deterrence by the law, or lacked the skills to recognize and refuse intoxicated customers. Noncompliance with the law on selling cannabis to apparently alcohol-intoxicated customers increases the risks of polysubstance impairment and harm.

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 Fell Consulting; Dr. Gary Cutter from the University of Alabama; and Lila Martinez, Amanda Brice, and Noah Chirico from Klein Buendel.

Development of an Online Cancer Prevention Intervention for Rural Emerging Adults

Development of an Online Cancer Prevention Intervention for Rural Emerging Adults

A multi-state research team from Arizona, Colorado, New Mexico, and Utah has published research on a rural health intervention in the Journal of Medical Internet Research. The study developed and pilot tested a theory-based intervention via the web to reduce six cancer risk factors among rural emerging adults through community-engaged research.

The rapid growth of user-generated web-based health information increases the complexity of cancer information seeking. One promising strategy for promoting high-quality cancer information consumption is through targeted interventions that are intentionally designed to reach individuals in the online spaces they occupy. However, there is a paucity of evidence-based information on the best strategies for designing and implementing web-based health behavior change interventions to improve individuals’ cancer-related knowledge and prevent cancer.

This mixed methods approach describes the development of an online cancer prevention intervention aimed at rural emerging adults aged 18-26 years in the United States and delivered in Facebook private groups. The intervention was guided by behavior change theory and co-created with young adults and Stakeholder Organization Advisory Boards to ensure relevance, accessibility, and appropriateness. The paper reported on three formative surveys, a pilot intervention, protocol development, and the community-engaged process for intervention development.

The authors developed 400 posts for a Facebook feed aimed at reducing six cancer risk behaviors (unhealthy diet, lack of physical activity, tobacco use, alcohol use, sun exposure, and human papillomavirus infection) with iterative input from the emerging adults and stakeholder advisory boards. Formative surveys with rural 297 emerging adults and a pilot study of the intervention with this 26 people from this population were conducted. In the pilot study, the intervention reached a sample of participants across several rural counties, with sustained engagement over a one-month period. Key modifications to the intervention content and design emerged from both advisory boards, the formative surveys, and the pilot intervention, focusing on using perceived reliable sources and direct links to source material.

The authors concluded that this web-based cancer prevention intervention is scalable and delivers engaging, evidence-informed health information to rural emerging adults. They offered key insights into the design and implementation of web-based cancer prevention interventions for emerging adults by describing the resources, timelines, and expertise needed to design and implement the intervention. Considerations for fully engaging young people and community stakeholder partners are presented, and how their involvement resulted in modifications that strengthened the intervention was discussed. Finally, the authors highlighted the importance of theory-based health-behavior messaging, digital messaging skillsets, and platform-tailored dissemination strategies for maximizing web-based intervention acceptability.

The research is supported by a grant from the National Cancer Institute (CA268037; Dr. David Buller and Dr. Andrew Sussman, Multiple Principal Investigators). Dr. Buller is the Director of Research at Klein Buendel. Dr. Sussman is from the University of New Mexico Comprehensive Cancer Center. Other collaborating investigators are from the University of Utah, the University of Arizona, the University of Colorado, and Colorado State University. The lead author of the Journal of Medical Internet Research paper is Dr. Echo Warner from the College of Nursing and the Huntsman Cancer Institute at the University of Utah.

2025 Research Highlights

2025 Research Highlights

In 2025, Klein Buendel scientists and staff pursued rigorous behavioral science research with numerous national collaborators. Our Creative Team designed and engineered multiple web-based programs to positively impact the health and safety of people’s everyday lives. Our Research Team started three new research projects with current and new collaborators. We published 17 research papers in peer-reviewed journals, including the American Journal of Public Health, and our research was presented at four national conferences.

In February, Dr. David Buller was an invited presenter at the Policy-based Research Workshop sponsored by New York University. His presentation was entitled “Research on Implementation of Alcohol and Cannabis Sales Policies.”

In April, the Creative Team’s development of the electronic version of the STAC bystander anti-bullying intervention for middle school students was illuminated in a life-size digital graphic LUMINARY presentation of the STAC-T Program at Boise State University.

Projects Launched in 2025

  1. “No Weigh Body Neutrality.” A Phase I SBIR award from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (DK142209; Dr. Kayla Nuss, Principal Investigator, Klein Buendel). 
  2. The Phase II Project of “Hybrid Delivery to Increase Access and Sustainability: Evaluating ezParent Implementation.” A Fast Track STTR grant to Klein Buendel from the National Institute (HD116627; Dr. Susan Breitenstein, Principal Investigator, Ohio State University). The primary Co-Investigator from Klein Buendel is Ms. Julia Berteletti.
  3. An Administrative Supplement was awarded to “Policy and training intervention in responsible marijuana sales practices to reduce the risk of selling to intoxicated customers.” A 5-year R01 grant from the National Institute on Alcohol Abuse and Alcoholism (AA031591; Dr. W. Gill Woodall and Dr. David Buller, Multiple Principal Investigators). 

For these new projects, we are collaborating with: 

  • Dr. Anne Poirier, a nationally recognized body image expert and the author of The Body Joyful and Not a Fat Annie; and
  • Dr. Susan Breitenstein from Ohio State University; and
  • Dr. Robert Saltz from the Prevention Research Center at the Pacific Institute for Research and Evaluation.

2025 Publications*

  1. McCrady BS, Woodall WG, Berteletti J, Starling R, Martinez L, Westerberg V, Brooks M, Starke T. Developing a smartphone web app to help DWI offenders and their families. J Subst Use Addict Treat. 2025 Jan:168:209565. doi: 10.1016/j.josat.2024.209565.
  2. Heckman CJ, Mitarotondo A, Buller D, Berteletti J, Schroth KRJ, Stapleton JL, Dellavalle RP, Balk SJ, Hudson SV. Analysis of facilitators of and barriers to enactment of state regulation of indoor tanning by minors, Transl Behav Med. 2025 Jan 16;15(1):ibaf044. doi: 10.1093/ tbm/ ibaf044.
  3. Nuss K, Jones ED, Brice AN, Udovich CC, Fullmer SE, Freeberg KA, McCarty NP, Seals DR, Craighead DH. Feasibility and design of a novel smartphone app to deliver blood pressure-lowering high-resistance inspiratory muscle strength training. Mhealth. 2025 Jan;11:6. doi:10.21037/mhealth-24-33.
  4. Buller DB, Berteletti J, Heckman C, Schroth KRJ, Gellar AC, Stapleton JL, Adjei A, Mitarotondo Am Guild SR, Gershenwald JE, Dellavalle D, Pagoto S. Bills to restrict access to and harm from indoor tanning facilities in US state legislatures, 1992‒2023. Am J Public Health. 2025 Feb;115(2):191-200. doi:10.2105/AJPH. 2024. 307894.
  5. Nuss K, Berteletti J, Walkosz B, Adjei I, Small A, Beltran LS, Chirico N, Poirier A, Arigo D. What is in a hashtag? A comparative content analysis of fitspiration, body positivity, and body neutrality posts on Instagram. Psychol Pop Media. 2025 Feb;14(4):560-571. doi: 10.1037/ppm0000585. 
  6. Midgett A, Doumas DM, Peralta C, Peck M, Reilly B, Buller MK. Usability testing of a bystander bullying intervention for rural middle schools: Mixed methods study. JMIR Hum Factors. 2025 Feb;12: e67962. doi: 10.2196/67962. 
  7. Salafia C, Banerjee S, Hamilton JG, Schofield E, Yuelin L, Buller DB, Hunley K, Sussman AL, Guest DD, Kaphingst KA, Berwick M, Hay JL. Salafia C, Banerjee S, Hamilton JG, et al. Prospective changes in primary care patients’ family communication after skin cancer genetic test offer. PEC Innov. 2025 Jun;7:100409. doi:10.1016/j.pecinn.2025.100409.
  8. Nuss K, Brice A, Hebert C, Nauta P, Stull AJ, Swift DL, Griffith DM, Buller DB, Newton RL Jr. A culturally tailored mHealth intervention (MobileMen app) to promote physical activity in African American men: Protocol for a comparative effectiveness trial. JMIR Res Protoc. 2025 Jul;14:e67809. doi:10.2196/67809.
  9. Meenan R, Buller DB, Berteletti J, Henry KL, Buller MK, Cutter GR, Pagoto S, Adjei I, Chirico N. Economic evaluation of two scalability strategies for nationwide dissemination of an occupational sun safety intervention in a randomized trial. J Occup Environ Med. 2025; 67(7):498-506. doi: 10.1097/JOM.0000000000003390.
  10. Buller DB, Kinsey A, Sullivan T, Gruetter P, Morrisey-Basler MC, Buller ID, Heckman CJ. Descriptive analysis of municipal policies addressing shade in eight southwest and northeast states in the United States. Front Public Health. 2025 Jul 14:13:1565251. doi: 10.3389/fpubh.2025.1565251.  eCollection 2025. PMCID: PMC12302959.
  11. Brice AN, Fullmer S, Barger C, Serbinski J, Gallik M, Nauta P, Swift DL, Stull AJ, Buller DB, Griffith DM, Nuss K, Newton RL Jr. MobileMen: the development of a mobile application to promote physical activity in African American men. Mhealth. 2025 Jul 14;11:32. doi: 10.21037/mhealth-24-82. eCollection 2025. 
  12. Manne SL, Kashy DA, Pagoto S, Peterson SK, Heckman CJ, Gallo J, Berger A, Buller DB, Kulik A, Frederick S, Pesanelli M. Engagement in and correlates of total cutaneous exams and skin self-exams among young melanoma survivors and their family. J Behav Med. 2025 Oct;48(5):834-847. doi:10.1007/s10865-025-00589-4. 
  13. Woodall WG, Buller DB, Zimet G, Kong AS, Reither J, Chilton L, Martinez L, Brooks M, Chirico N, Ginossar T. TeenVac.org: A mobile web app to improve human papillomavirus vaccine uptake for adolescent boys. J Adolesc Health. 2025 Oct;77(4):749-755. doi: 10.1016/j.jadohealth.2025.06.015. 
  14. Doumas DM., Midgett A, Hausheer R, Winburn A, Buller M, Perron T, Shelton J, Herbeck B. Acceptability, relevance, and short-term outcomes of the STAC-T bullying bystander app: Feasibility quantitative study. JMIR Form Res. 2025 Nov 18:9:e76830. doi: 10.2196/76830. 
  15. Saltz R, Paschall MJ, O’Hara S, Buller DB, Woodall WG, Martinez L. Mandatory responsible beverage service training in California associated with higher refusals of service to apparently intoxicated patrons. J Stud Alcohol Drugs. 2025 Nov:10.15288/jsad.25-00161. doi: 10.15288/jsad. 25-00161.
  16. Woodall WG, McCrady BS, Westerberg V, Berteletti J, Martinez L, Brooks M, Starke T, Chirico N. Randomized trial shows smartphone support app for DWI offenders and their families reduced alcohol use and ignition interlock device lockouts. J Stud Alcohol Drugs. 2025 Dec. doi:10.15288/ jsad.25-00171. Online ahead of print. 
  17. Buller DB, Adjei I, Agarwal R, Peterson SR, Escoffery C, Buller MK, Walkosz BJ, Anderson K, Morshed A. Systematic review and narrative synthesis of behavioral interventions to improve heat-related illness prevention in community and occupational populations. BMC Pub Health. 2025 Dec. https://doi.org/10.1186/s12889-025-25499-7. 

*KB investigators and staff are indicated in bold type  

2025 Conference Presentations 

Multiple presentations on research progress, procedures, analyses, and outcomes were given by Klein  Buendel scientists, staff, and their collaborators at the following national conferences: 

  • 46th Annual Meeting of the Society of Behavioral Medicine (March) 
  • 48th Annual Scientific Meeting of the Research Society on Alcohol (June) 
  • Gerontological Society of America Annual Scientific Meeting (November) 
  • 18th Annual Conference of the Science of Dissemination and Implementation in Health (December) 

Who Gives a Hoot about Heat?

Who Gives a Hoot about Heat?

Extreme heat is the leading cause of weather-related deaths. Prevention includes personal practices and emergency procedures. Behavioral interventions to improve prevention of heat-related illnesses are a priority.

A multi-institutional research team led by Emory University and Klein Buendel has published a systematic review and narrative synthesis of behavioral interventions to improve heat-related illness prevention in community and occupational populations. The research team was assisted by a public health informationist from the Woodruff Health Sciences Center Library at Emory University. The paper has been published in the journal, BMC Public Health.

Utilizing systematic review methodology, a comprehensive search strategy was deployed to identify studies reporting evaluations of behavioral heat-illness prevention interventions. Data sources included prominent bibliographic databases and relevant grey literature searches. Inclusion criteria indicated that studies that enrolled adult participants, assessed heat-related outcomes quantitatively, and were published in English from January 2000 to October 2023 be included. Data on study design, intervention features, and outcomes from the retained studies were extracted. A narrative synthesis was conducted, given the small number of studies and heterogeneous features.

Seventeen articles reporting on results from 13 studies were retained. Samples included outdoor workers, professional athletes, or community members (20,154 participants). Study quality was variable, with only two studies classified as good quality. Outcomes assessed were cognitive variables (such as knowledge, attitudes, and intentions), behaviors (such as water intake and dehydration), and clinical indicators (such as kidney function). Seven studies evaluated a health education intervention, two studies tested warning messages, and two studies focused on provision of personal protection equipment. Interventions improved self-reported heat-illness knowledge and prevention behaviors, and reduced deaths. Kidney function and health were improved in two studies. 

The published literature on behavioral heat-related illness prevention interventions was limited, despite frequent periods of high heat. The published evidence suggested that interventions can improve prevention knowledge and behavior and possibly reduce heat injury. Study designs need substantial improvement by including larger samples and randomized designs with comparison groups to avoid threats to internal and external validity in existing data. Policy efforts should be considered along with health education and provision of personal protection equipment to ensure populations are adequately protected.

This research was supported by a grant (U48DP006377) from the Centers for Disease Control and Prevention to the Emory University Prevention Research Center (Dr. Alex Morshed from Emory University and Dr. David Buller from Klein Buendel, MPIs). Additional authors on this publication include Ms. Radhika Agarwal, Dr. Shenita Peterson, Dr. Cam Escoffery, and Ms. Kayla Anderson from Emory University; and Ms. Irene Adjei, Ms. Mary Buller, and Dr. Barbara Walkosz from Klein Buendel.

B-SMART App for DWI Offenders and Family Reduced Alcohol Use and Ignition Interlock Device Lockouts

B-SMART App for DWI Offenders and Family Reduced Alcohol Use and Ignition Interlock Device Lockouts

Driving while intoxicated (DWI) remains a preventable source of morbidity and mortality in the United States. Ignition interlock devices (IIDs) are used to prevent DWI offenders from driving while intoxicated during a mandated installation period and are effective during that time. Once IIDs are removed, DWI rates are like levels of offenders who had no IID.

Researchers at Klein Buendel and the University of New Mexico have published the results of a study that tested the efficacy of a new smartphone app (B-SMART) for DWI offenders with an IID and concerned family members, with the goal of reducing IID alcohol consumption and lockout events. The full paper with methods, analyses, and results has been published in the Journal of Studies on Alcohol and Drugs.

Four B-SMART app modules were developed: 1) Life with Interlock, 2) Supporting Changes in Drinking, 3) Doing Things Together, and 4) Effective Communication. Participants (pairs of DWI offenders and concerned family members) were randomly assigned to receive the B-SMART app (n=58) or referral to a state IID information page, considered usual and customary care (n=65), and followed for nine months. IID data (failed tests and lockout events) were obtained from IID providers as the primary outcome variables. Offender and CFM reports of alcohol consumption in the last 30 days prior to assessment were secondary measures.

IID data were collected on 62% (n=76) of participants. B-SMART participants had significantly fewer lockout events than usual and customary care participants. B-SMART offenders and their concerned family members reported significantly less likelihood of DWI offender drinking at the 9-month follow-up.

Results suggest the B-SMART app reduced DWI offender alcohol consumption and IID lockout events. These outcomes are important because fewer IID lockout events predict lower DWI recidivism.

This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA022850; Dr. W. Gill Woodall, Principal Investigator). Collaborators on this paper include Dr. Barbara McCrady and Dr. Vern Westerberg from the University of New Mexico; and Julia Berteletti, Lila Martinez, Marita Brooks, and Noah Chirico from Klein Buendel; and Thomas Starke from Impact DWI. The B-SMART app was developed by the Creative Team at Klein Buendel.

Evaluation of Go Sun Smart Georgia

Evaluation of Go Sun Smart Georgia

The evaluation results of a workplace sun safety research project were presented at the 18th Annual Conference on the Science of Dissemination and Implementation in Health held December 14-17, 2025, in Washington, DC. Dr. Cam Escoffery from Emory University was the presenting author. The presentation complemented the conference theme of “Realizing the Benefits of Dissemination & Implementation Science.”

African American and Hispanic workers face unique skin cancer risks and are underrepresented in sun safety intervention research. To support sun safety practice in occupational settings with racially/ethnically heterogeneous populations, we adapted an evidence-based sun safety program—Go Sun Smart Georgia (GSSG)—to better serve African American and Hispanic outdoor workers and evaluated it in local governments. Program implementation outcomes are described.

The study enrolled seven local public employers in Georgia in 2024 and randomly assigned them to intervention (3 sites) or delayed intervention (comparison) group (4 sites), stratified by government type (municipal/county) and size (≥100/<100 employees). GSSG included training of peer coaches; written audit of the employers’ sun safety policies and practices; 45-minute online employee training; and a resource website. Program materials were adapted with culturally relevant language and imagery. GSSG was delivered over a four-month period in June-October. Implementation outcomes were collected via surveys and implementation logs: GSSG delivery, worksite sun safety policy adoption or modification, skin cancer and heat illness prevention practice use and penetration, and GSSG acceptability.

Two county governments and five municipalities (3 large, 2 small) in Southwest/East Georgia participated and 48 managers and 156 outdoor workers were assessed. Compared to the comparison group, outdoor workers in the intervention worksites had higher level of information about UV and heat protective behaviors; more workers recalled receiving skin cancer and heat training; and more reported sharing sun safety information from work at home. Uptake of GSSG policy components was slow; no sites requested a policy audit, one requested a model sun safety policy. Both managers and outdoor workers rated GSSG materials highly (an average of 4.29 out of 5 stars).

The adapted GSSG was well received and improved knowledge and sharing of sun safety practices among outdoor workers. Systematic adaptation of effective interventions for novel populations is important for increasing reach and impact of evidence in sun safety interventions and addressing disparities in cancer prevention.

This research was supported by a grant (U48DP006377) from the U.S. Centers for Disease Control and Prevention to the Emory University Prevention Research Center (Dr. Alex Morshed from Emory University and Dr. David Buller from Klein Buendel, Multiple Principal Investigators). Additional authors on the poster presentation included Mary Buller, Dr. Barbara Walkosz, and Irene Adjei from Klein Buendel; and Dr. Cam Escoffery, Helen Singer, April Hermstad, and Dr. Regine Haardörfer from Emory University. 

Mandatory Training Increases Drink Refusals to Intoxicated Patrons in California

Mandatory Training Increases Drink Refusals to Intoxicated Patrons in California

Klein Buendel scientists and staff are collaborators on a study that evaluated mandatory responsible beverage service training in California and its association with higher refusals of service to apparently intoxicated patrons in drinking establishments. The study, led by Dr. Robert Saltz at the Pacific Institute for Research and Evaluation, has been published in the Journal of Studies on Alcohol and Drugs.

The California Responsible Beverage Service (RBS) Training Act mandated training for all alcohol servers by 2023, giving this multi-institutional research team a rare opportunity to see how a statewide initiative might influence server behavior.

In 2022, 300 licensed on-premises establishments were sampled in nine counties in and around the San Francisco Bay Area. From July 2022 to January 2023, pseudo-patron and observer teams visited each establishment, and pseudo-patrons attempted to buy alcohol while displaying obvious signs of intoxication. The outcome of each purchase attempt and characteristics of establishments, servers, and pseudo-patrons, and month, day, and time, were recorded. In 2024, the same premises were visited as a follow up.

At baseline, 19.6% of the outlets refused service to the pseudo-patron. At follow up, the refusal rate increased significantly to 39.2% in a regression model controlling for establishment, server, and pseudo-patron characteristics. A typology of establishments (such as sports bar, casual restaurant, fine dining restaurant) did not show any association with refusal rate except that fine dining places refused more often than other types of establishments. Observers’ ratings of how obvious the pseudo-patron’s apparent intoxication was strongly associated with refusals.

The researchers conclude that there was substantial improvement in alcohol over-service refusals two years after the California mandatory RBS training law went into effect.

This research was funded by a grant to PIRE from the National Institute on Alcohol Abuse and Alcoholism (AA028772; Dr. Robert Saltz, Principal Investigator).  Co-authors include Dr. Mallie Paschall and Dr. Sharon O’Hara from PIRE; and Dr. W. Gill Woodall, Dr. David Buller, and Ms. Lila Martinez from Klein Buendel.  

Feasibility of the STAC-T Bullying Bystander App

Feasibility of the STAC-T Bullying Bystander App

Bullying is a significant public health issue, with approximately 25% of middle school students reporting being a target of bullying in the past year. STAC is an evidence-based bullying bystander intervention for middle school students. A multi-institutional research team developed a technology-based version of STAC (STAC-T) and evaluated the acceptability and relevance of the program, as well as how acceptability and relevance are related to the use of specific skills (STAC strategies) students learn in the program. Significance, methods, data, and results have been published in the scientific journal, JMIR Formative Research.

STAC-T, which included a 40-minute training and a 15-minute booster session, was completed by 249 middle school students recruited from six middle schools in rural, low-income communities in the United States. Students completed a post-training survey assessing program acceptability and relevance, whether they witnessed bullying post-training, and the use of the STAC strategies to intervene in bullying situations. Descriptive statistics were used to assess acceptability, relevance, and the use of STAC strategies. Linear regression analysis was used to assess the relationship of program acceptability and relevance to STAC strategy use.

Most students reported the program was acceptable (82.1 to 90.0%) and relevant (78.6 to 83.0%) for students at their school; 88.8% (111) of the 50.2% (125) of students who witnessed bullying post-training also reported the use of at least one STAC strategy to intervene when witnessing bullying. Program relevance was a significant predictor of post-training use of STAC strategies. In contrast, program acceptability was not a significant predictor of post-training STAC strategy use.

This study provides support for the acceptability and relevance of STAC-T, as well as the effectiveness in promoting the use of the STAC strategies to intervene in bullying situations. Further, program relevance was related to STAC strategy use, highlighting the importance of assessing program relevance for specific student populations.  

The multi-institutional team was led by Dr. Aida Midgett from Boise State University. Collaborators included Dr. Diana Doumas, Taylor Perron, and Jennalyn Shelton from Boise State University; Dr. Robin Hausheer from the University of Vermont; Dr. Amanda Winburn from the University of Mississippi; and Brandon Herbeck and Mary Buller from Klein Buendel. The research was supported by a grant to Klein Buendel from the National Institute on Minority Health and Health Disparities (R42MD014943; Dr. Aida Midgett, Principal Investigator).

Just Care Simulated Usability Testing

Just Care Simulated Usability Testing

Growing numbers of people will grow old and die while incarcerated. A team from The Penn State University Ross and Carol Nese College of Nursing and Klein Buendel participated in a panel presentation at the Gerontology Society of America Annual Scientific Meeting on November 12-15 in Boston, MA, to discuss their research on caring for the aged and dying in prison.

The panelist, Dr. Erin Kitt-Lewis from Penn State, presented a pragmatic approach to the usability testing of Just Care. Just Care is a 7-module digital program to train people living in prison to assist staff by providing care to their peers who are older or dying. The web-based program educates prison staff on the needs of chronically ill, aging, and dying people who are incarcerated and provides implementation tools for providing care. Research evidence supports using peer caregivers to assist staff with geriatric and end-of-life care.

The Just Care team learned that gaining access to conduct research with external technology is limited at some correctional facilities as many are reassessing their technology capacity and policies, especially with limited staff. As a result, a pragmatic approach to conducting the research was necessary. In collaboration with the prison administration at one state prison system that had instituted restricted access to technology, an innovative approach — simulated usability testing — to test the program using focus groups was developed.

A total of six focus groups, two with staff and four with people living in prison, were held at one men’s and one women’s prison in a mid-Atlantic State; nine staff and 28 peer caregivers participated. The modified approach involved two on-site researchers conducting the focus groups while projecting the Just Care e-learning on a large screen and interacting with participants. Simultaneously, two off-site researchers connected via videoconference to screen share Just Care and take handwritten field notes. Participants were asked to comment on the content, feasibility, clarity, and ease of use of the program. 

Analysis of the qualitative data collected from the simulated usability testing resulted in three themes: barriers, facilitators, and future directions for the program. Each of these were described by the panelist in some detail.

This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging (AG057239; Dr. Susan Loeb from Penn State and Dr. Barbara Walkosz from Klein Buendel, Multiple Principal Investigators). Additional collaborators include Dr. Erin Kitt-Lewis, Dr. Kalei Crimi, and Nawal Alsearhi from the Ross and Carol Nese College of Nursing at Penn State University; and Amanda Brice and Steve Fullmer from Klein Buendel.