Mary Klein Buller

Extreme heat is the leading cause of weather-related deaths. Prevention includes personal practices and emergency procedures. Behavioral interventions to i

BACKGROUND Bullying is a significant problem in the United States (U.S.) with 1 in 4 students reporting being a target of bullying. The majority of students indicate they witness bullying as bystanders but do not know what to do to intervene. School-wide, comprehensive programs are generally effective in reducing bullying, but they often lack a focus on bystander training. Additionally, comprehensive, school-wide programs are expensive and place a high demand on schools for implementation. STAC-T is a new technology-based bullying intervention app that is designed to be both brief and focused on training student bystanders to intervene. Researchers have demonstrated the usability, acceptability, feasibility, and relevance of the STAC-T app. Previous studies have also shown that among students trained in STAC-T, those who witnessed bullying post-training indicated using at least of one STAC intervention strategy to defend peers. OBJECTIVE The aim of the current study is to build upon the initial findings supporting the use of the STAC-T app by investigating the efficacy of the program. Objectives included examining if relative to students in the control condition, students trained in STAC-T would report: (a) greater increases in knowledge of bullying and confidence to intervene in bullying situations and (b) decreases in bullying victimization. METHODS A sample of 613 participants recruited from six middle schools in the Northeast, South, and Northwest regions of the U.S. were randomly assigned by classroom periods to either the STAC-T intervention condition or assessment-only control condition. We used linear mixed models to examine changes in outcome variables from baseline to the 30-day follow-up. RESULTS We found a significant interaction effect for Time x Group (p < .001) for knowledge and confidence to intervene, with students in the intervention group reporting a greater increase in knowledge and confidence to intervene compared to students in the control group. Similarly, results revealed a significant interaction effect for Time x Group (p < .01) for bullying victimization, with students in the intervention group reporting a significantly greater decrease in bullying victimization compared to students in the control group. CONCLUSIONS Results from this randomized control trial demonstrate the efficacy of STAC-T in increasing students’ knowledge and confidence to intervene and reducing bullying victimization. Our findings provide support for the STAC-T app as a promising and sustainable approach to bullying intervention for middle schools. CLINICALTRIAL Clinicaltrials.gov NCT05572398

Background: Bullying is a significant public health issue, with approximately 25% of middle school students reporting being a target of bullying in the past year. Students who are targets of bullying or witness bullying are at high risk for negative mental health outcomes, including depression and anxiety. STAC is an evidence-based bullying bystander intervention for middle school students, with program outcomes that include reductions in bullying perpetration and victimization, as well as associated mental health risks. We developed a technology-based version of STAC (STAC-T) to reduce implementation barriers associated with in-person bullying prevention programs. STAC-T is an interactive app that includes a 40-minute training and a 15-minute booster session. Objective: This study aimed to evaluate the acceptability and relevance of the STAC-T program. We were also interested in how program acceptability and relevance are related to the use of specific bystander intervention skills (eg, STAC strategies) students learn in the program. Methods: This study was part of a larger study in which students recruited from 6 middle schools in rural, low-income communities in the United States were randomized to either the STAC-T intervention or a control condition. Participants in this study were 229 students in the intervention group who completed the 30-day follow-up survey, including the acceptability and relevance questionnaire. The survey assessed program acceptability and relevance, whether or not students witnessed bullying posttraining, 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. Results: Of the 229 student participants, the majority reported the program was acceptable (188, 82.1%, to 206, 90.0%) and relevant (180, 78.6%, to 190, 83.0%) for students at their school. Of the 54.6% (125/229) of students who witnessed bullying posttraining, 88.8% (111/125) reported the use of at least one STAC strategy to intervene when witnessing bullying. Students were most likely to use the STAC bystander intervention strategies Turning it Over and Accompanying Others , relative to Stealing the Show and Coaching Compassion . Regression analyses revealed that program relevance was a significant predictor of posttraining use of STAC strategies ( P =.016). In contrast, program acceptability was not a significant predictor of posttraining STAC strategy use ( P =.660). Conclusions: This study provides support for the acceptability and relevance of STAC-T and its effectiveness in promoting the use of the STAC strategies to intervene in bullying situations. Furthermore, program relevance was related to STAC strategy use, highlighting the importance of assessing program relevance for specific student populations.

BACKGROUND 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. OBJECTIVE We 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 (e.g., STAC strategies) students learn in the program. METHODS 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 or not 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. RESULTS The majority of students reported the program was acceptable (82.1% - 90.0%; n = 188-206) and relevant (78.6% - 83.0%; n = 180-190) for students at their school; 88.8% (n = 111) of the 50.2% (n = 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 (p = .02). In contrast, program acceptability was not a significant predictor of post-training STAC strategy use (p = .69). CONCLUSIONS 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. CLINICALTRIAL Clinicaltrials.gov NCT05572398

Objective: An economic evaluation of methods for scaling up the Go Sun Smart at Work (GSS@W) occupational sun protection program was conducted. Methods: Regional districts (n = 138) in 21 state departments of transportation were randomized to digital or in-person scalability strategies for GSS@W. Cost of delivering GSS@W was obtained from project accounting records and manager reports. Incremental cost-effectiveness ratio between digital and in-person strategies was calculated. Results: Program-delivery costs (in thousands) were $15.6 in digital and $74.3 in in-person strategies. Across all districts, the incremental cost-effectiveness ratio was $3305, representing average cost savings from a sun safety action not implemented under the digital strategy but implemented under the in-person strategy. Conclusions: The digital scalability strategy was cost-effective relative to an in-person strategy, generating substantial cost savings and offsetting a lower mean number of implemented program actions.

Background: Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. Objective: We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. Methods: A sample of 21 participants (n=10, 48% school personnel; n=11, 52% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90% (9/10) rated the program with 4 or 5 stars. Among students, 91% (10/11) stated they would recommend the program to others, and 100% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. Conclusions: The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application.

BACKGROUND Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. OBJECTIVE We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. METHODS A sample of 21 participants (n=10, 48% school personnel; n=11, 52% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. RESULTS Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90% (9/10) rated the program with 4 or 5 stars. Among students, 91% (10/11) stated they would recommend the program to others, and 100% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. CONCLUSIONS The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application.

Objective: Two methods for scaling up an evidence-based occupational sun protection program were compared. Methods: Regional districts (n = 138) in 21 state Departments of Transportation throughout the United States were randomized to receive the Go Sun Smart at Work program via in-person or digital scalability methods in 2019–2022 in 1:2 ratio. Managers completed pretest and posttest surveys and employees completed posttest surveys. Because of the COVID pandemic, only posttest measures were analyzed (n = 255 managers; n = 1387 employees). Results: After scale-up, more employees reported training (b = 0.381, P = 0.021) and communication (b = 0.112, P = 0.049) at workplaces in in-person rather than digital strategy. There were no differences in managers’ reports of sun protection training, communication, or actions by scalability method (P > 0.05). Conclusions: Occupational sun protection was implemented during program scale up and employees recalled training/communication more in the in-person than digital strategy.

Background: Bullying is a significant problem for youth associated with wide-ranging negative consequences. Providing students who witness bullying with intervention strategies to act as defenders can reduce bullying and negative associated outcomes for both targets and bystanders. Educating teachers about bullying and training them to support students to intervene as defenders may increase the efficacy of bystander programs as teachers’ attitudes and responses to bullying relate to bystander behavior. This is particularly important in middle school, when bullying peaks and rates of reporting bullying to teachers begin to decline. Reducing implementation barriers, including limited time and resources, must also be considered, particularly for schools in low-income and rural areas. Technology-based programs can increase access and scalability but require participant buy-in for adoption. Objective: We used a mixed methods design to inform the development of the STAC teacher module, a companion training to a brief bullying bystander intervention. STAC stands for the four bystander intervention strategies: Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion. Objectives included examining the effectiveness of the STAC teacher module and informing the translation of the training into a technology-based format that can be used as a companion to the technology-based STAC. Methods: A sample of 17 teachers recruited from 1 middle school in a rural, low-income community completed pre- and posttraining surveys assessing immediate outcomes (ie, knowledge, confidence, comfort, and self-efficacy), intention to use program strategies, and program acceptability and relevance, followed by a qualitative focus group obtaining feedback regarding program appropriateness, feasibility, content, perception of need, and desire for web-based training. Descriptive statistics, 2-tailed independent-sample t tests, and thematic analyses were used to analyze the data. Results: Assessment of pre- and posttraining surveys indicated that teachers reported an increase in knowledge and confidence to support defenders, confidence and comfort in managing bullying, and bullying self-efficacy. Furthermore, most participants reported that they were likely or very likely to use STAC strategies to support students who intervene in bullying. Quantitative and qualitative data revealed that participants found the training easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on ways of improving the program, including revising role-plays and guidance on understanding student behavior. Participants shared positive perceptions regarding program feasibility and need for bullying-specific prevention, the most significant barriers being cost and parent buy-in, suggesting the importance of including parents in the prevention process. Finally, participants shared the strengths of a web-based program, including ease of implementation and time efficiency, while indicating the importance of participant engagement and administration buy-in. Conclusions: This study demonstrates the effectiveness of the STAC teacher module in increasing knowledge and bullying self-efficacy and provides support for developing the module, including key information regarding considerations for web-based translation.