Pale and Sober: Reducing
Problems Associated with HighRisk Drinking and UV Exposure
Kimberly A. Mallett, Ph.D.
The Pennsylvania State
University
Today’s Discussion
 Research Background and Lab Overview
 Project Options: Design and Preliminary Outcomes
 Project Achieve: Research Objectives and Progress
Rob Turrisi, Ph.D.
Kimberly Mallett, Ph.D.
Professor/Director
Associate Professor/Clinical Director
___________________________
Projects: Achieve, ACT, iStart, Options, PACT,
PIRE, Skin Watch, Style
Projects: Achieve, ACT, iStart, Options,
PACT,
PIRE, Skin Watch
Racheal Reavy, Ph.D.
Michael Cleveland, Ph.D.
Assistant Professor/Research Associate
_________________________________
Projects: Achieve, ACT, iStart, PACT,
PIRE, Emerge
Research Associate
_________________________________
Projects: Achieve, iStart, PACT, PIRE,
Skin Watch
Lindsey Varvil-Weld, M.S.
Graduate Research Assistant
______________________
Projects: ACT, PACT, PIRE,
Skin Watch
Aimee Read, B.S.
Research Coordinator/IRB Coordinator
_____________________________
Projects: Achieve, ACT, Options, PACT
PIRE, Skin Watch
Nichole Scaglione, M.S., CHES
Graduate Research Assistant
______________________________
Projects: Achieve, iStart, PACT,
PIRE, Skin Watch
Sarah Favero, M.S.
Research Coordinator
__________________________
Projects: Achieve, iStart, PACT, PIRE,
Skin Watch
Undergraduate Research Assistants
Rachel Cotter
Chloe Strader
Shelly Erb
_________________________________
(Multi-Project)
Holly Gunn, M.D., M.P.H
Research Associate
_________________________________
Projects: Style
Brittney Hultgren, B.A.
Graduate Research Assistant
____________________________
Projects: iStart, PACT,
PIRE, Skin Watch, Style
Carly Comer, B.S.
Research Technician
______________________________
Projects: Achieve, ACT, iStart, Options,
PACT, PIRE, Skin Watch
Undergraduate Research Assistants
Lindsey Wilde
Kate Barbara
Casey Bartoe
Daniel Doxbeck
(PIRE Project)
Catilin Mill
Laura Moser
Christina Nguyen
Raquel Phiilips
Diana Poorman
Administrative
Staff
_______________________
Projects: Achieve, ACT, iStart,
Options, PACT, PIRE,
Skin Watch
Main Contact
Phone: 814-865-5041
Email: dlp20@psu.edu
Project Options
Enhancing Patient Communication Among Dermatologists
R03 CA144435-01 – NIH/NCI
Principal Investigator: Kimberly Mallett, Ph.D.
Co-Investigator: Rob Turrisi, Ph.D.
Collaborators: June Robinson, M.D. (PI-NWU); Elizabeth
Billingsley (Co-I PSHMC); Aimee Read, B.S. (Project
Coordinator-PSU)
Project Skin Watch
A Comparison of Intervention Methods to Teach Melanoma Patients Skin SelfExamination
R01 CA154908-01 – NIH/NCI
Principal Investigator: June Robinson, M.D. (NWU)
Co-Investigator: Rob Turrisi, Ph.D. (PI-PSU); Kimberly Mallett, Ph.D. (Co-I-PSU)
Collaborators: Aimee Read, B.S. & Sarah Favero, M.S. (Project Coordinators-PSU); Rikki
Gaber, B.A. (Project Coordinator-NWU)
Project iStart
An Appearance-Based Intervention to Reduce Teen Skin Cancer Risk
R01 CA134891-02 – NIH/NCI
Principal Investigator: Joel Hillhouse, Ph.D. (ETSU)
Co-Investigator: Rob Turrisi, Ph.D. (PI-PSU)
Investigators: Michael Cleveland, Ph.D., Kimberly Mallett, Ph.D.
Collaborators: Katie Baker, M.P.H. (ETSU); Sarah Favero (Project
Coordinator–PSU)
Project Achieve
A Longitudinal and Person-Centered Study of College Alcohol Consequences
R01 AA021117-01A1 – NIH/NIAAA
Principal Investigator: Kimberly Mallett, Ph.D.
Co-Investigators: Rob Turrisi, Ph.D., Michael Cleveland, Ph.D.
Collaborators: Racheal Reavy, Ph.D., Aimee Read, B.S. & Sarah Favero, M.S.
(Project Coordinators)
Project PACT
A Longitudinal Study of Parent Communication with College
Students about Alcohol
R01 AA012529-09A1 – NIH/NIAAA
Principal Investigator: Rob Turrisi, Ph.D.
Co-Investigator: Kimberly Mallett, Ph.D.
Collaborators: Mary Larimer, Ph.D. (PI-UW); Michelle
Hospital, Ph.D. (PI-FIU); Sarah Favero, M.S. (Project
Coordinator–PSU)
Project Zero-Tolerance (PIRE)
A Community Based Zero Tolerance Program: Completing the Model of
Minimal Legal Drinking Age Enforcement
R01 AA017186-01A2 – NIH/NIAAA
Principal Investigator: Rob Turrisi, Ph.D.
Investigators: Kimberly Mallett, Ph.D., Michael Cleveland, Ph.D.
Collaborators: Mark Johnson, Ph.D. (PI-PIRE); Eileen Taylor, M.S. (Project
Coordinator–PIRE); Aimee Read, B.S. (Project Coordinator–PSU)
Areas of Interest
 High Risk Health Behaviors
 High risk individuals
 Etiology and Intervention Studies
 Brief
 Sustainable
 Motivational Interviewing
 Enhancing communication
 Training
 Fidelity
 Unique analytical approaches
 LPA & LCA
Enhancing Patients’
Satisfaction and Sun Protective
Behaviors Using the ABC
Method of Physician-Patient
Communication
Project OPTIONS
Skin Cancer Risk & Usual Patient
Behavior
 Incidence and mortality from skin cancer is
on the rise in the U.S. in recent decades,
especially among people ages 15 to 39.1
 Despite knowing the risk, many patients
frequently fail to use optimal UV
protection.2
 Education alone is not effective to change
an individual’s behavior, especially among
less motivated patients.
o Frustrating for both physicians and patients
1Jemal
et al. 2011, 2 Soto et al. 2010
Treatment As Usual
 Traditional way physicians convey the importance of
wearing sunscreen.
o Instruct patients in wearing sunscreen and sun protective
behaviors.
o Prescriptive and directive in nature.
o Patient’s motivations and challenges are typically not
willfully addressed.
 Good solutions for engaging in healthy behaviors from
a provider’s perspective may be difficult to achieve
from the patient’s own perspective; thus resulting in
no behavioral change.
Solution:
Enhance Communication
Develop a behavioral intervention for
dermatologists to deliver to patients during a
skin examination in order to increase patients’
UV protective behaviors.
A Patient-Centered Approach
 Motivational Interviewing (MI) has been
successful in improving a variety of healthrelated behaviors.3
o Empathic and non-judgmental communication style
o Collaboration is key
 Most dermatologists are unfamiliar with this
communication technique.4
 Dermatologists who observed MI principles
integrated in physician-patient
conversations about sun protection felt this
communication tool useful.5
3Rollnick
et al. 2008, 4Levinson et al. 2000, 5Mallett et al. 2008
Project OPTIONS
 NCI funded longitudinal study
 Intervention was developed by
Mallett & colleagues and based
on the principles of MI.
 Phase 1 of study focused on
training physicians to deliver the
ABC (Addressing Behavioral
Change) Intervention.
The ABC Intervention
 A 2-3 minute physician-facilitated intervention
during a regular skin exam.
 The ABC Method consists of six components:
1)
2)
3)
4)
5)
6)
Assess UV risk
Assess sunscreen use
Explore barriers to using sunscreen
Facilitate patient generated solutions to barriers
Assess/Discuss use of other sun protection
Summarize patients’ motivations and their ideas for
improved
The First Question…
Can dermatologists
learn and deliver the
ABC Intervention
with good fidelity
over a sustained
period of time?
Methods
 8 dermatologists at Penn State Hershey Medical Center participated.
o Voluntary & had no impact on departmental standing.
 Physicians attended two 1-hour intervention training sessions post
baseline data collection.
 Following training, physicians were shadowed by a trainer as they
delivered the ABC Method to actual patients.
o Feedback provided for 3 patients per physician
o Asked to use the ABC Method with patients over next 6 months
 Fidelity assessed by coding patient visits at baseline, immediately
after training, and at 3- and 6-month follow-ups.
 Dermatologists completed 6 monthly self-report surveys assessing:
o Frequency of using the ABC Intervention
o Satisfaction with method
An Example - Baseline
 _0_ Outdoor activities OR # of sunburns/too much sun per year
 _0_ Assessed willingness to use sun screen on a scale of 1-10
 _0_ Assessed barriers to using sunscreen
 _0_ Inquired about possible solutions
 _1_ Asked about other method of sun protection AND offered relevant
options
 _0_ Summarized patient willingness to use sun protection and possible
enhancements/solutions
 _1_ Assessed use of sunscreen
Key
0=
1=
2=
3=
Component not delivered
Component delivered
Patient volunteered the component
Not applicable
An Example – 9 month Follow-up
 _1_ Outdoor activities OR # of sunburns/too much sun per year
 _1_ Assessed willingness to use sun screen on a scale of 1-10
 _1_ Assessed barriers to using sunscreen
 _1_ Inquired about possible solutions
 _1_ Asked about other method of sun protection AND offered relevant
options
 _1_ Summarized patient willingness to use sun protection and possible
enhancements/solutions
 _1_ Assessed use of sunscreen
Key
0=
1=
2=
3=
Component not delivered
Component delivered
Patient volunteered the component
Not applicable
Physician Fidelity & Satisfaction
Mallett et al., 2011 Archives of Dermatology
The Next Question…
How does the implementation of the
ABC intervention during routine skin
exams affect patient outcomes?
Methods
 60 dermatology patient participants; 30 per site
o Penn State Hershey Medical Center (Treatment)
o Northwestern University Faculty Foundation (Control)
o 75% female; ages 21-85
 Treatment group received ABC Method during session
& control group received treatment as usual.
 Following their appointment, all participants
completed an anonymous survey assessing:
o use of sunscreen & sun protective behaviors
o Feelings toward physician communication
Patient Blind Assessment of ABC
Method Delivery by Physician
Core Components of
ABC Method
Intervention
M
Control
M
P value
Assess patient’s UV risk
5.40
(1.65)
2.37
(2.57)
< .001
Assess patient’s sunscreen
use
5.93
(0.37)
1.20
(2.12)
< .001
Assess patient’s barriers to
using sunscreen
5.57
(0.90)
0.77
(1.79)
< .001
Discuss possible solutions
5.77
(0.63)
0.67
(1.67)
< .001
Assess other methods of
sun protection
5.67
(0.84)
0.73
(1.84)
< .001
Summarize conversation
5.55
(0.95)
1.21
(2.24)
< .001
*Rated on a 7-point scale
Patient Intentions & Communication
Satisfaction by Condition
Items
Intervention
M
Control
M
P value
Intends to increase
sunscreen use
5.14
(1.30)
3.17
(1.83)
< .001
Intends to use sunscreen
before outdoor activities
5.59
(1.21)
4.38
(1.76)
.004
Liked the way doctor
communicated about
sunscreen
5.97
(0.18)
3.47
(2.16)
< .001
*Rated on a 7-point scale
Mallett et al., 2012 Archives of Dermatology
Patient Intentions & Communication
Satisfaction by Condition
*Mean comparisons above are significantly different, where p < 0.01.
Discussion & Implications
 Treatment patients reported
o higher satisfaction with their care
o higher intentions to increase
sunscreen use
o higher intentions to practice sun
protective behaviors
relative to control patients.
 Shows promise for a brief and
sustainable physician-delivered
approach to enhance both
patient care and protective
behaviors in a dermatological
setting.
Future Directions
 How will physicians’ use of the ABC
Intervention influence patients’ actions
over time?
 R21 pending to examine patient outcomes
at 3 and 6 month follow up.
 Develop standardized training for
physicians.
A Longitudinal and PersonCentered Study of College Alcohol
Consequences
Project ACHIEVE
Drinking & Consequences
 Alcohol-related consequences
continue to be a problem
among college students
 A significant portion of variance
in consequences is unaccounted
for by drinking alone2,3
 What are other unique
predictors of consequences?
1Hingson
et al., 2009
2Larimer et al., 2004
3Mallett
et al., 2011
Unique Predictors of
Consequences
 Willingness to experience consequences1
 Many students don’t perceive consequences as
“negative”2
 Subjective evaluations are key
 Norms about consequences3,4
 Protective behavioral strategies5,6,7
 Interventions may not be as useful
1Mallett
et al., 2011
2Mallett et al., 2008
3Lee
et al., 2010;
4Labrie et al., 2010
5Lewis
et al., 2011
6Martens et al., 2004
7Ray
et al., 2009
High-Risk Students
 MRC Group
 Experienced several different consequences
repeatedly (i.e., > 6 different consequences
and > 5 consequences repeatedly)
 Consisted of 23% of the sample, but accounted
for 48% of reported consequences
 Does this group mature out?
Mallett, Marzell, Varvil-Weld, Turrisi, Guttman, & Abar, 2011 (Addictive
Behaviors)
ACHIEVE will examine:
 Impact of contextual changes on drinking
(moving, turning 21)
 Subgroups of students who are at higher
risk (i.e. MRC group) to better target them
with interventions
 Development of chronic alcohol use
patterns and problems
Conceptual Model
Off to a good start!
 Completed Recruitment December 2012
 N=2,025 first year college students;
drinkers only
 55% Female, 85% White
 67% Response Rate
 Participants complete 1 web based survey
per semester for 8 semesters
 $30 Visa gift card (escalates each year)
Questions?