Claudine Legault

Wake Forest School of Medicine, Winston-Salem, North Carolina, United States

Are you Claudine Legault?

Claim your profile

Publications (74)459.21 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Report the radiographic and MRI structural outcomes of an 18-month study of diet-induced weight loss, with or without exercise, compared to exercise alone in older, overweight and obese adults with symptomatic knee osteoarthritis. Prospective, single-blind, randomized controlled trial that enrolled 454 overweight and obese (BMI = 27-41 kg.m(-2)) older (age ≥ 55 yrs) adults with knee pain and radiographic evidence of femorotibial osteoarthritis. Participants were randomized to one of three 18-month interventions: diet-induced weight loss only (D); diet-induced weight loss plus exercise (D+E); or exercise-only control (E). X-rays (N = 325) and MRIs (N=105) were acquired at baseline and 18 month follow-up. X-ray and MRI (cartilage thickness and semi-quantitative (SQ)) results were analyzed to compare change between groups at 18-month follow-up using analysis of covariance (ANCOVA) adjusted for baseline values, baseline BMI, and gender. Mean baseline descriptive characteristics of the cohort included: age, 65.6 yrs.; BMI 33.6 kg.m(-2); 72% female; 81% white. There was no significant difference between groups in JSW loss; D -0.07 (SE 0.22)mm, D+E -0.27 (SE 0.22)mm and E -0.16 (SE 0.24)mm (p=0.79). There was also no significant difference in MRI cartilage loss between groups; D -0.10(0.05) mm, D+E -0.13(0.04)mm and E -0.05(0.04)mm (p=0.42). Despite the potent effects of weight loss in this study on symptoms as well as mechanistic outcomes (such as joint compressive force and markers of inflammation), there was no statistically significant difference between the three active interventions on the rate of structural progression either on x-ray or MRI over 18-months. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
    Osteoarthritis and Cartilage 04/2015; 23(7). DOI:10.1016/j.joca.2015.03.034 · 4.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Using three separate models that included total body mass, total lean and total fat mass, and abdominal and thigh fat as independent measures, we determined their association with knee joint loads in older overweight and obese adults with knee osteoarthritis (OA). Methods: Fat depots were quantified using computed tomography, and total lean and fat mass were determined with dual energy x-ray absorptiometry in 176 adults (age, 66.3 yr; body mass index, 33.5 kg.m(-2)) with radiographic knee OA. Knee moments and joint bone-on-bone forces were calculated using gait analysis and musculoskeletal modeling. Results: Higher total body mass was significantly associated (P <= 0.0001) with greater knee compressive and shear forces, compressive and shear impulses (P < 0.0001), patellofemoral forces (P < 0.006), and knee extensor moments (P = 0.003). Regression analysis with total lean and total fat mass as independent variables revealed significant positive associations of total fat mass with knee compressive (P = 0.0001), shear (P < 0.001), and patellofemoral forces (P = 0.01) and knee extension moment (P = 0.008). Gastrocnemius and quadriceps forces were positively associated with total fat mass. Total lean mass was associated with knee compressive force (P = 0.002). A regression model that included total thigh and total abdominal fat found that both were significantly associated with knee compressive and shear forces (P <= 0.04). Thigh fat was associated with knee abduction (P = 0.03) and knee extension moment (P = 0.02). Conclusions: Thigh fat, consisting predominately of subcutaneous fat, had similar significant associations with knee joint forces as abdominal fat despite its much smaller volume and could be an important therapeutic target for people with knee OA.
    Medicine &amp Science in Sports &amp Exercise 09/2014; 46(9):1677-1683. DOI:10.1249/MSS.0000000000000293 · 4.46 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the influences of frontal plane knee alignment and obesity on knee joint loads in older, overweight and obese adults with knee osteoarthritis.
    Osteoarthritis and Cartilage 05/2014; DOI:10.1016/j.joca.2014.05.013 · 4.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aims to obtain preliminary data on the efficacy of yoga for reducing self-reported menopausal hot flashes in a randomized study including an attention control group. We randomized 54 late perimenopausal women (2-12 mo of amenorrhea) and postmenopausal women (>12 mo of amenorrhea)-aged 45 to 58 years and who experienced at least four hot flashes per day, on average, for at least 4 weeks-to one of three groups: yoga, health and wellness education (HW), and wait list (WL). Yoga and HW classes consisted of weekly 90-minute classes for 10 weeks. All women completed daily hot flash diaries throughout the trial (10 wk) to track the frequency and severity of hot flashes. The mean hot flash index score is based on the number of mild, moderate, severe, and very severe hot flashes. Hot flash frequency declined significantly across time for all three groups, with the strongest decline occurring during the first week. There was no overall significant difference in hot flash frequency decrease over time by treatment groups, but the yoga and HW groups followed similar patterns and showed greater decreases than the WL group. On week 10, women in the yoga group reported an approximately 66% decrease in hot flash frequency, women in the HW group reported a 63% decrease, and women in the WL group reported a 36% decrease. The hot flash index showed a similar pattern. Results suggest that yoga can serve as a behavioral option for reducing hot flashes but may not offer any advantage over other types of interventions.
    Menopause (New York, N.Y.) 01/2014; DOI:10.1097/GME.0000000000000191 · 2.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine the influences of frontal plane knee alignment and obesity on knee joint loads in older, overweight and obese adults with knee osteoarthritis. Methods Cross-sectional investigation of alignment and obesity on knee joint loads using community dwelling older adults (age ≥ 55 yrs.; 27 kg.m-2 ≥ BMI ≤ 41 kg.m-2; 69% female) with radiographic knee osteoarthritis that were a subset of participants (157 out of 454) enrolled in the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial. Results A higher BMI was associated with greater (p = 0.0006) peak knee compressive forces [overweight, 2411 N (2182, 2639), class 1 obesity, 2772 N (2602, 2943), class 2+ obesity, 2993 N (2796, 3190)] and greater (p = 0.004) shear forces [overweight, 369 N (322, 415), class 1 obesity, 418 N (384, 453), class 2+ obesity, 472 N (432, 513)], independent of alignment, and varus alignment was associated (p < 0.0001) with greater peak external knee adduction moments, independent of BMI [valgus, 18.7 Nm (15.1, 22.4), neutral, 27.7 Nm (24.0, 31.4), varus, 37.0 Nm (34.4, 39.7)]. Conclusion BMI and alignment were associated with different joint loading measures; alignment was more closely associated with the asymmetry or imbalance of loads across the medial and lateral knee compartments as reflected by the frontal plane external adduction moment, while BMI was associated with the magnitude of total tibio-femoral force. These data may be useful in selecting treatment options for knee osteoarthritis patients (e.g., diet to reduce compressive loads or bracing to change alignment).
    Osteoarthritis and Cartilage 01/2014; · 4.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: IMPORTANCE Knee osteoarthritis (OA), a common cause of chronic pain and disability, has biomechanical and inflammatory origins and is exacerbated by obesity. OBJECTIVE To determine whether a >= 10% reduction in body weight induced by diet, with or without exercise, would improve mechanistic and clinical outcomes more than exercise alone. DESIGN, SETTING, AND PARTICIPANTS Single-blind, 18-month, randomized clinical trial at Wake Forest University between July 2006 and April 2011. The diet and exercise interventions were center-based with options for the exercise groups to transition to a home-based program. Participants were 454 overweight and obese older community-dwelling adults (age >= 55 years with body mass index of 27-41) with pain and radiographic knee OA. INTERVENTIONS Intensive diet-induced weight loss plus exercise, intensive diet-induced weight loss, or exercise. MAIN OUTCOMES AND MEASURES Mechanistic primary outcomes: knee joint compressive force and plasma IL-6 levels; secondary clinical outcomes: self-reported pain (range, 0-20), function (range, 0-68), mobility, and health-related quality of life (range, 0-100). RESULTS At 18 months, 399 participants (88%) completed the study. Compared with exercise participants, knee compressive forces were lower in diet participants and IL-6 levels were lower in diet and diet + exercise participants. [GRAPHICS] CONCLUSIONS AND RELEVANCE Among overweight and obese adults with knee OA, after 18 months, participants in the diet + exercise and diet groups had more weight loss and greater reductions in IL-6 levels than those in the exercise group; those in the diet group had greater reductions in knee compressive force than those in the exercise group.
    JAMA The Journal of the American Medical Association 09/2013; 310(12):1263-73. DOI:10.1001/jama.2013.277669 · 30.39 Impact Factor
  • Source
    Osteoarthritis and Cartilage 04/2013; 21:S85. DOI:10.1016/j.joca.2013.02.184 · 4.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT Objectives: This study examined the relationship between positive and negative affect, depressive symptoms, and cognitive performance. Methods: The sample consisted of 1479 non-demented, postmenopausal women (mean age = 67 years) at increased risk of breast cancer enrolled in the National Surgical Adjuvant Breast and Bowel Project's Study of Tamoxifen and Raloxifene. At each annual visit, women completed a standardized neuropsychological battery and self-report measures of affect and depression. Data from three visits were used in linear mixed models for repeated measures using likelihood ratio tests. Separate analyses were performed to relate positive/negative affect and depression to each cognitive measure. Results: Higher positive affect was associated with better letter fluency (p = .006) and category fluency (p < .0001). Higher negative affect was associated with worse global cognitive function (p < .0001), verbal memory (CVLT List B; p = .002), and spatial ability (p < .0001). Depressive symptoms were negatively associated with verbal knowledge (p = .004), figural memory (p < .0001), and verbal memory (p's ≤ .0001). Discussion: Findings are consistent with some prior research demonstrating a link between positive affect and increased verbal fluency and between depressive symptoms and decreased memory. The most novel finding shows that negative affect is related to decreased global cognition and visuospatial ability. Overall, this research in a large, longitudinal sample supports the notion that positive affect is related to increases and negative affect to decreases in performance on distinct cognitive measures.
    Aging Neuropsychology and Cognition 12/2012; DOI:10.1080/13825585.2012.747671 · 1.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Few studies have examined the risk behaviors of youth who run away and return home. Most studies have focused on youth who end up as chronic runaways or become homeless for whom the expected trajectory is a path filled with numerous negative outcomes.Methods: Using data from a multisite phone survey of a random sample of youth aged 16–20 years (N = 1191), we present comparisons of runaways and non-runaways on demographic and background variables, alcohol and drug use, and sexual behavior (sex without birth control). Also, reasons for running away and services received after running away were examined.Results: Runaway status was strongly associated with each of the risk behaviors examined. The adjusted odds ratios for runaway status were higher for all behaviors (alcohol use, binge drinking, illegal prescription drug use, and sex without birth control) compared with the odds ratios for the other independent variables. More than half of runaways reported running away because of family problems, and only about one-third received any services after the most recent runaway episode.Conclusions: The findings from this study suggest that running away from home is a risk factor for future risky behaviors (substance use and sex without birth control), even when youth return home and do not end up on the streets. Interventions are needed for youth who return home as it cannot be assumed that returning eliminates the risk of using substances or engaging in sex without birth control.
    Vulnerable Children and Youth Studies 09/2012; DOI:10.1080/17450128.2012.687843
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: To evaluate the validity and reliability of a cognitive test battery and questionnaires administered by telephone. DESIGN: Observational study; 110 participants randomly assigned to receive two administrations of the same cognitive test battery 6 months apart in one of four combinations (Time 1 administration/Time 2 administration): telephone/telephone, telephone/face to face, face to face/telephone, face to face/face to face. SETTING: Academic medical center. PARTICIPANTS: One hundred ten women aged 65 to 90 without dementia. MEASUREMENTS: The battery included tests of attention; verbal learning and memory; verbal fluency; executive function; working memory; global cognitive functioning; and self-reported measures of perceived memory problems, depressive symptoms, sleep disturbance, and health-related quality of life. Test-retest reliability, concurrent validity, relative bias associated with telephone administration, and change scores were evaluated. RESULTS: There were no statistically significant differences in scores on any of the cognitive tests or questionnaires between participants randomly assigned to telephone or face-to-face administration at the Time 1 assessment, indicating equivalence across administration modes. There was no significant bias for tests or questionnaires administered by telephone (P's > .01), nor was there a difference in mean change scores between administration modes except for Category Fluency (P = .01) and California Verbal Learning Test long-delay free recall (P = .004). Mean test-retest coefficients for the battery were not significantly different between groups, although individual test-retest correlation coefficients were generally higher within modes than between modes. CONCLUSION: Telephone administration of cognitive tests and questionnaires to older women is reliable and valid. Use of telephone batteries can substantially reduce the cost and burden of cognitive assessments and increase enrollment, retention, and data completeness, thereby improving study validity.
    Journal of the American Geriatrics Society 09/2012; 60(9):1616-1623. DOI:10.1111/j.1532-5415.2012.04111.x · 4.22 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To assess correlates of physical activity, and to examine the relationship between physical activity and physical functioning, in 160 older (66 ± 6 years old), overweight/obese (mean body mass index = 33.5 ± 3.8 kg/m2), sedentary (less than 30 mins of activity, 3 days a week) individuals with knee osteoarthritis. Methods: Physical activity was measured with accelerometers and by self-report. Physical function was assessed by 6-min walk distance, knee strength, and the Short Physical Performance Battery. Pain and perceived function were measured by questionnaires. Pearson correlations and general linear models were used to analyze the relationships. Results: The mean number of steps taken per day was 6209 and the average PAEE was 237 ± 124 kcal/day. Participants engaged in 131 ± 39 minutes of light physical activity (LPA) and 10.6 ± 8.9 minutes of moderate-vigorous physical activity (MPA/VPA). Total steps/day, PAEE, and minutes of MPA/VPA were all negatively correlated with age. The 6-min walk distance and lower extremity function were better in those who had higher total steps/day, higher PAEE, higher minutes of MPA/VPA, and a higher PASE score. Conclusions: This study demonstrates that a population who has higher levels of spontaneous activity have better overall physical function than those who engage in less activity.
    Journal of Physical Activity and Health 08/2012; 10(6):777-83. · 1.95 Impact Factor
  • Source
    Osteoarthritis and Cartilage 04/2012; 20:S28. DOI:10.1016/j.joca.2012.02.549 · 4.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Growth and sex steroid hormones decrease with aging and obesity. The effect of dietary weight loss and exercise training lifestyle interventions was examined on hormones as well as determining their relationships with physical function in older obese and overweight adults. Individuals were randomized into one of four 18 month interventions: Healthy Lifestyle (HL), Exercise, Diet, and Exercise-Diet. Clinical research setting with facility based exercise and nutrition education and behavior classrooms. Older (≥60 yrs) overweight and obese (BMI≥28 kg/m(2)) adults with knee osteoarthritis (n=309) were recruited for the study. Weight loss goal for Diet groups was ≥5%. Exercise groups trained (mostly walking and resistance training) 3 days/week for 60 min/session. Body weight, growth hormone (GH), corticosterone, sex-hormone binding globulin (SHBG), testosterone, and dehydroepiandrosterone (DHEA) were measured at baseline, 6, and 18 months. Physical function was determined through performance task (6-min walking distance) and self-reported questionnaires (Western Ontario McMaster University Osteoarthritis Index-WOMAC) at similar time points. Diet, Exercise, and Exercise-Diet groups lost 4.9%, 3.5%, and 6.2% of their weight at 18 months, respectively. There was a significant diet treatment effect on GH levels in women as higher concentrations of this hormone were apparent following dietary weight loss intervention (p=0.01). No other hormones were affected by either diet or exercise treatments in men or women. A significant inverse correlation between baseline 6-minute walking distance and SHBG (r=-0.33) was found in men. The increase in basal GH levels from the diet treatment in women suggests that this lifestyle behavior intervention may mitigate the age- and obesity-related decreases in growth hormone levels, to help preserve muscle mass, strength, and physical function in older adults.
    The Journal of Nutrition Health and Aging 01/2012; 16(2):169-74. DOI:10.1007/s12603-011-0152-z · 2.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is a need to identify evidenced-based obesity treatments that are effective in maintaining lost weight. Weight loss results in reductions in energy expenditure, including spontaneous physical activity (SPA) which is defined as energy expenditure resulting primarily from unstructured mobility-related activities that occur during daily life. To date, there is little research, especially randomized, controlled trials, testing strategies that can be adopted and sustained to prevent declines in SPA that occur with weight loss. Self-monitoring is a successful behavioral strategy to facilitate behavior change, so a provocative question is whether monitoring SPA-related energy expenditure would override these reductions in SPA, and slow weight regain. This study is a randomized trial in older, obese men and women designed to test the hypothesis that adding a self-regulatory intervention (SRI), focused around self-monitoring of SPA, to a weight loss intervention will result in less weight and fat mass regain following weight loss than a comparable intervention that lacks this self-regulatory behavioral strategy. Participants (n=72) are randomized to a 5-month weight loss intervention with or without the addition of a behavioral component that includes an innovative approach to promoting increased SPA. Both groups then transition to self-selected diet and exercise behavior for a 5-month follow-up. Throughout the 10-month period, the SRI group is provided with an intervention designed to promote a SPA level that is equal to or greater than each individual's baseline SPA level, allowing us to isolate the effects of the SPA self-regulatory intervention component on weight and fat mass regain.
    Contemporary clinical trials 12/2011; 33(2):450-5. DOI:10.1016/j.cct.2011.11.019 · 1.99 Impact Factor
  • Source
    Osteoarthritis and Cartilage 09/2011; 19. DOI:10.1016/S1063-4584(11)60194-5 · 4.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The efficacy of non-pharmacological intervention approaches such as physical activity, strength, and cognitive training for improving brain health has not been established. Before definitive trials are mounted, important design questions on participation/adherence, training and interventions effects must be answered to more fully inform a full-scale trial. SHARP-P was a single-blinded randomized controlled pilot trial of a 4-month physical activity training intervention (PA) and/or cognitive training intervention (CT) in a 2 × 2 factorial design with a health education control condition in 73 community-dwelling persons, aged 70-85 years, who were at risk for cognitive decline but did not have mild cognitive impairment. Intervention attendance rates were higher in the CT and PACT groups: CT: 96%, PA: 76%, PACT: 90% (p=0.004), the interventions produced marked changes in cognitive and physical performance measures (p≤0.05), and retention rates exceeded 90%. There were no statistically significant differences in 4-month changes in composite scores of cognitive, executive, and episodic memory function among arms. Four-month improvements in the composite measure increased with age among participants assigned to physical activity training but decreased with age for other participants (intervention*age interaction p=0.01). Depending on the choice of outcome, two-armed full-scale trials may require fewer than 1,000 participants (continuous outcome) or 2,000 participants (categorical outcome). Good levels of participation, adherence, and retention appear to be achievable for participants through age 85 years. Care should be taken to ensure that an attention control condition does not attenuate intervention effects. Depending on the choice of outcome measures, the necessary sample sizes to conduct four-year trials appear to be feasible. Clinicaltrials.gov Identifier: NCT00688155.
    BMC Geriatrics 05/2011; 11:27. DOI:10.1186/1471-2318-11-27 · 2.00 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To examine the performance of the Telephone Interview for Cognitive Status (TICS) for identifying participants appropriate for trials of physical activity and cognitive training interventions. Volunteers (N=343), ages 70-85 years, who were being recruited for a pilot clinical trial on approaches to prevent cognitive decline, were administered TICS and required to score ≥ 31 prior to an invitation to attend clinic-based assessments. The frequencies of contraindications for physical activity and cognitive training interventions were tallied for individuals grouped by TICS scores. Relationships between TICS scores and other measures of cognitive function were described by scatterplots and correlation coefficients. Eligibility criteria to identify candidates who were appropriate candidates for the trial interventions excluded 51.7% of the volunteers with TICS<31. TICS scores above this range were not strongly related to cognition or attendance at screening visits, however overall enrollment yields were approximately half for participants with TICS=31 versus TICS=41, and increased in a graded fashion throughout the range of scores. Use of TICS to define eligibility criteria in trials of physical activity and cognitive training interventions may not be worthwhile in that many individuals with low scores would already be eliminated by intervention-specific criteria and the relationship of TICS with clinic-based tests of cognitive function among appropriate candidates for these interventions may be weak. TICS may be most useful in these trials to identify candidates for oversampling in order to obtain a balanced cohort of participants at risk for cognitive decline.
    International Journal of Geriatric Psychiatry 02/2011; 26(2):135-43. DOI:10.1002/gps.2503 · 3.09 Impact Factor
  • Annals of Behavioral Medicine; 01/2011
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to examine the effects of high weight loss on knee joint loads during walking in participants with knee osteoarthritis (OA). Data were obtained from a subset of participants enrolled in the Arthritis, Diet, and Activity Promotion Trial (ADAPT). Complete baseline and 18-month follow-up data were obtained on 76 sedentary, overweight or obese older adults with radiographic knee OA. Three-dimensional gait analysis was used to calculate knee joint forces and moments. The cohort was divided into high (>5%), low (<5%), and no (0% or gain) weight loss groups. From baseline body weight, the high weight loss group lost an average of 10.2%, the low weight loss group lost an average of 2.7%, and the no weight loss group gained 1.5%. Adjusted 18-month outcome data revealed lower maximum knee compressive forces with greater weight loss (P=0.05). The difference in compressive forces between the high weight loss and no weight loss groups was due primarily to lower hamstring forces (P=0.04). Quadriceps forces were similar between the groups at 18-month follow-up. There was no difference between the groups in 18-month joint space width or Kellgren-Lawrence scores. These results suggest that a 10% weight loss in an overweight and obese osteoarthritic population elicits positive changes in the mechanical pathway to knee OA by having lower knee joint compressive loads during walking compared to low and no weight loss groups. The difference in compressive forces was due, in large part, to reductions in hamstring co-contraction during the initial portion of the stance phase.
    Osteoarthritis and Cartilage 12/2010; 19(3):272-80. DOI:10.1016/j.joca.2010.11.010 · 4.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Geriatric Psychiatry Outreach (GO) Program began in 2005 and provides in-home psychiatric evaluation and treatment for older adults who have difficulty getting to an office-based setting. An initial assessment was conducted on the first 100 patients seen by the program and follow-up treatment was provided as clinically indicated. The mean age of patients seen was 79.7 (SD: 8.2), 74% were women, and the most common psychiatric diagnoses were depression (50%) and dementia (45%), with a mean of 1.4 (SD: 0.6) psychiatric diagnoses per patient. The patients had a mean of 4.8 (SD: 2.9) medical diagnoses and were on a mean of 6.8 (SD: 4.0) prescription and 2.2 (SD: 1.2) nonprescription medications. Patients received a mean of 4.2 (SD: 4.2) in-person visits and a mean of 30.2 (SD: 36.5) additional contacts related to their care, such as phone calls, e-mails, and faxes. Providing psychiatric services at home for older adults with mental illness is a much needed but rarely available service. Such patients typically have a complex combination of medical and psychiatric diagnoses and benefit from contacts in addition to the face-to-face visits.
    The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 12/2010; 18(12):1141-5. DOI:10.1097/JGP.0b013e3181dd1c64 · 3.52 Impact Factor

Publication Stats

4k Citations
459.21 Total Impact Points

Institutions

  • 1999–2015
    • Wake Forest School of Medicine
      • • Division of Public Health Sciences
      • • Department of Biostatistical Sciences
      Winston-Salem, North Carolina, United States
  • 2007–2014
    • Wake Forest University
      • • Department of Biostatistical Sciences
      • • Department of Public Health Sciences
      • • Department of Health and Exercise Science
      Winston-Salem, North Carolina, United States
  • 2010
    • Stanford University
      Palo Alto, California, United States
    • Winston-Salem State University
      Winston-Salem, North Carolina, United States
  • 2004
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 1998
    • University of Iowa
      Iowa City, Iowa, United States