Melinda L Irwin

Yale University, New Haven, Connecticut, United States

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Publications (126)746.93 Total impact

  • Journal of Clinical Oncology 09/2015; DOI:10.1200/JCO.2015.63.1440 · 18.43 Impact Factor
  • Melinda L Irwin · Carol Fabian · Anne McTiernan
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    ABSTRACT: Obesity and low levels of physical activity are associated with a higher risk of breast cancer recurrence and mortality. Currently, over 65 % of breast cancer survivors are overweight or obese, and fewer than 30 % engage in recommended levels of physical activity. The reason for low adherence to lifestyle guidelines is likely multifactorial. Given the continuing trend of increased obesity and physical inactivity in the United States, worldwide and in breast cancer survivors, more research showing the direct effect of weight loss and/or exercise on breast cancer recurrence and mortality is needed. Many exercise interventions have examined the impact of increasing exercise on changes in quality of life, with most studies showing a favorable effect of exercise on quality of life. Smaller Phase II randomized trials using biomarkers as surrogate endpoints is likely appropriate to answer questions regarding mechanisms of action, exercise type, volume, and intensity, yet a definitive trial of weight loss and exercise on disease-free survival is critical for moving the field forward. Research is also necessary on how to disseminate lifestyle interventions into the clinic and community that lead to clinically meaningful weight losses of at least 5 % that are maintained over time, and favorable sustained changes in physical activity levels. Changes in referrals, access, and reimbursement of lifestyle programs may lead to favorable changes in the prevalence of obesity and physical activity in breast cancer survivors and in turn rates of breast cancer recurrence and mortality.
    Advances in Experimental Medicine and Biology 06/2015; 862:193-212. DOI:10.1007/978-3-319-16366-6_13 · 1.96 Impact Factor
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    ABSTRACT: Purpose Arthralgia occurs in up to 50% of breast cancer survivors treated with aromatase inhibitors (AIs) and is the most common reason for poor AI adherence. We conducted, in 121 breast cancer survivors receiving an AI and reporting arthralgia, a yearlong randomized trial of the impact of exercise versus usual care on arthralgia severity. Patients and Methods Eligibility criteria included receiving an AI for at least 6 months, reporting ≥ 3 of 10 for worst joint pain on the Brief Pain Inventory (BPI), and reporting < 90 minutes per week of aerobic exercise and no strength training. Participants were randomly assigned to exercise (150 minutes per week of aerobic exercise and supervised strength training twice per week) or usual care. The BPI, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were completed at baseline and at 3, 6, 9, and 12 months. Intervention effects were evaluated using mixed-model repeated measures analysis, with change at 12 months as the primary end point. Results Over 12 months, women randomly assigned to exercise (n = 61) attended 70% (± standard deviation [SD], 28%) of resistance training sessions and increased their exercise by 159 (± SD, 136) minutes per week. Worst joint pain scores decreased by 1.6 points (29%) at 12 months among women randomly assigned to exercise versus a 0.2-point increase (3%) among those receiving usual care (n = 60; P < .001). Pain severity and interference, as well as DASH and WOMAC pain scores, also decreased significantly at 12 months in women randomly assigned to exercise, compared with increases for those receiving usual care (all P < .001). Conclusion Exercise led to improvement in AI-induced arthralgia in previously inactive breast cancer survivors.
    Journal of Clinical Oncology 04/2015; 33(10):1104-11. DOI:10.1200/JCO.2014.57.1547. · 18.43 Impact Factor
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    ABSTRACT: This was a feasibility study with the primary purpose to identify women with a diagnosis of breast cancer for survivorship care plan (SCP) delivery at the postoperative visit and deliver an SCP after treatment. The secondary purpose was to determine if patients' knowledge about their diagnosis, treatment, and risk for future adverse events improved with the SCP. Sixty-seven English-speaking women older than age 18 years with stage I-III breast cancer were enrolled at their postoperative appointment. The participants' treatment was tracked through the electronic medical record; SCPs were generated based on information abstracted from the records. After treatment completion, participants received an SCP during a routine follow-up appointment. Knowledge of tumor, treatments, adverse events, and screening recommendations were assessed before receiving the SCP and 2 months later. Accuracy at baseline and follow-up were compared using the McNemar test. One hundred twenty-nine visits were screened to identify 75 eligible participants. Seventy-five eligible participants (100%) agreed to enroll, and 71 (95%) were given an SCP. Participants were more accurate in reporting details about their history, screening recommendations, and potential adverse events at follow-up than they were at baseline for most measures, but the only statistically significant changes were found with stage (P = .0016) and increased risk of leukemia (P = .0348). It is feasible to identify and deliver SCPs to women with breast cancer who are approached during the postoperative visit in a surgical clinic. Additionally, SCPs seem to improve patient knowledge in several areas. Copyright © 2015 by American Society of Clinical Oncology.
    Journal of Oncology Practice 03/2015; 11(2):e170-6. DOI:10.1200/JOP.2015.005173
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    ABSTRACT: Background: Survival after an ovarian cancer diagnosis is poor. Given the high mortality in these patients, efforts to identify modifiable lifestyle behaviors that could influence survival are needed. Earlier evidence suggests a protective role for vegetables, but no prior studies have evaluated overall dietary quality and ovarian cancer survival. The purpose of this analysis was to evaluate the role of prediagnosis diet quality in ovarian cancer survival. Methods: We identified 636 centrally adjudicated cases of ovarian cancer within the Women's Health Initiative Observational Study or Clinical Trials of 161808 postmenopausal women followed from 1995 to 2012. Dietary quality was assessed for the Healthy Eating Index (2005) using a food frequency questionnaire, covariables were obtained from standardized questionnaires, and adiposity was measured by clinic-based measurements of height, weight, and waist circumference. The association between diet quality and mortality was analyzed using Cox proportional hazards regression, adjusted for potential confounders, and stratified by waist circumference, physical activity level, and diabetes status. Tests of statistical significance were two-sided. Results: Overall, higher diet quality was associated with lower all-cause mortality after ovarian cancer (hazard ratio [HR] for highest vs lowest tertile = 0.73; 95% confidence interval [CI] = 0.55 to 0.97, P(trend) = .03). The effect was strongest among women with waist circumference of 88 cm or less and with no history of diabetes (HR = 0.73, 95% CI = 0.54 to 0.98). Physical activity level did not modify the association between diet quality and survival. Conclusion: Our results suggest that overall higher prediagnosis diet quality may protect against mortality after ovarian cancer.
    JNCI Journal of the National Cancer Institute 11/2014; 106(11). DOI:10.1093/jnci/dju314 · 12.58 Impact Factor
  • Apoorva Tewari · Melinda Irwin · Anees Chagpar
    Cancer Research 09/2014; 74(19 Supplement):5039-5039. DOI:10.1158/1538-7445.AM2014-5039 · 9.33 Impact Factor
  • Melinda L Irwin
    Journal of Clinical Oncology 06/2014; 32(21). DOI:10.1200/JCO.2014.56.4583 · 18.43 Impact Factor
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    ABSTRACT: Background Ovarian cancer is often diagnosed at late stages and consequently the 5-year survival rate is only 44%. However, there is limited knowledge of the association of modifiable lifestyle factors, such as physical activity and obesity on mortality among women diagnosed with ovarian cancer. The purpose of our study was to prospectively investigate the association of (1) measured body mass index (BMI), and (2) self-reported physical activity with ovarian cancer-specific and all-cause mortality in postmenopausal women enrolled in the Women's Health Initiative (WHI). Methods Participants were 600 women diagnosed with primary ovarian cancer subsequent to enrollment in WHI. Exposure data, including measured height and weight and reported physical activity from recreation and walking, used in this analysis were ascertained at the baseline visit for the WHI. Cox proportional hazard regression was used to examine the associations between BMI, physical activity and mortality endpoints. Results Vigorous-intensity physical activity was associated with a 26% lower risk of ovarian cancer specific-mortality (HR = 0.74; 95% CI: 0.56–0.98) and a 24% lower risk of all-cause mortality (HR = 0.76; 95% CI: 0.58–0.98) compared to no vigorous-intensity physical activity. BMI was not associated with mortality. Conclusions Participating in vigorous-intensity physical activity, assessed prior to ovarian cancer diagnosis, appears to be associated with a lower risk of ovarian cancer mortality.
    Gynecologic Oncology 04/2014; 133(1):4–10. DOI:10.1016/j.ygyno.2014.01.033 · 3.77 Impact Factor
  • Cancer Research 03/2014; 73(24 Supplement):S3-03-S3-03. DOI:10.1158/0008-5472.SABCS13-S3-03 · 9.33 Impact Factor
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    ABSTRACT: Background: Vegetable consumption among preschool children is below recommended levels. New evidence-based approaches to increase preschoolers' vegetable intake, particularly in the child care setting, are needed. This study tests the effectiveness of two community-based randomized interventions to increase vegetable consumption and willingness to try vegetables: (1) the pairing of a vegetable with a familiar, well-liked food and (2) enhancing the visual appeal of a vegetable. Methods: Fifty-seven preschoolers enrolled in a Child and Adult Care Food Program-participating child care center participated in the study; complete lunch and snack data were collected from 43 and 42 children, respectively. A within-subjects, randomized design was used, with order of condition counterbalanced. For lunch, steamed broccoli was served either on the side of or on top of cheese pizza. For a snack, raw cucumber was served either as semicircles with chive and an olive garnish or arranged in a visually appealing manner (in the shape of a caterpillar). Paired t-tests were used to determine differences in consumption of meal components, and McNemar's test was performed to compare willingness to taste. Results: Neither visual appeal enhancement nor pairing with a liked food increased vegetable consumption. Pairing increased willingness to try the vegetable from 79% to 95% of children (p=0.07). Greater vegetable intake occurred at snack than at lunch. Conclusions: Further research should explore the strategy of pairing vegetables with liked foods. Greater consumption at snack underscores snack time as a critical opportunity for increasing preschool children's vegetable intake.
    Childhood Obesity 01/2014; 10(1). DOI:10.1089/chi.2013.0115 · 1.87 Impact Factor
  • Article: Response.
    Journal of the National Cancer Institute 01/2014; DOI:10.1093/jnci/djt377 · 12.58 Impact Factor
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    ABSTRACT: Objective. Breast cancer survivors are highly sedentary, overweight, or obese, which puts them at increased risk for comorbid chronic disease. We examined the prevalence of, and changes in, metabolic syndrome following 6 months of an aerobic exercise versus usual care intervention in a sample of sedentary postmenopausal breast cancer survivors. Design and Methods. 65 participants were randomized to an aerobic exercise intervention (EX) (n = 35) mean BMI 30.8 (±5.9) kg/m(2) or usual care (UC) (n = 30) mean BMI 29.4 (±7.4) kg/m(2). Metabolic syndrome prevalence was determined, as well as change in criteria and overall metabolic syndrome. Results. At baseline, 55.4% of total women met the criteria for metabolic syndrome. There was no statistically significant change in metabolic syndrome when comparing EX and UC. However, adhering to the exercise intervention (at least 120 mins/week of exercise) resulted in a significant (P = .009) decrease in metabolic syndrome z-score from baseline to 6 months (-0.76 ± 0.36) when compared to those who did not adhere (0.80 ± 0.42). Conclusions. Due to a higher prevalence of metabolic syndrome in breast cancer survivors, lifestyle interventions are needed to prevent chronic diseases associated with obesity. Increasing exercise adherence is a necessary target for further research in obese breast cancer survivors.
    International Journal of Endocrinology 11/2013; 2013(3):168797. DOI:10.1155/2013/168797 · 1.95 Impact Factor
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    ABSTRACT: The American Society of Preventive Oncology (ASPO) is a professional society for multi-disciplinary investigators in cancer prevention and control. The ASPO Junior Members Interest Group promotes the interests of predoctoral, postdoctoral, and junior faculty members within the Society, and provides them with career development and training opportunities. To this end, as part of the 37th ASPO Annual Meeting held in Memphis, Tennessee in March 2013, the Junior Members Interest Group organized a session designed to address issues faced by early-career investigators as they navigate the transition to become an independent, well-funded scientist with a sustainable program of research in the current climate of reduced and limited resources. Four speakers were invited to provide their complementary but distinct perspectives on this topic based on their personal experiences in academic, research-intensive positions and in federal funding agencies. This report summarizes the main themes that emerged from the speakers' presentations and audience questions related to mentoring; obtaining grant funding; publishing; developing expertise; navigating appointments, promotion, and tenure; and balancing demands. These lessons can be used by early-career investigators in cancer prevention and control as they transition to independence and build programs of fundable research. Cancer Epidemiol Biomarkers Prev; 22(11); 2138-42. ©2013 AACR.
    Cancer Epidemiology Biomarkers & Prevention 11/2013; 22(11):2138-42. DOI:10.1158/1055-9965.EPI-13-0807 · 4.13 Impact Factor
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    ABSTRACT: The purpose of this study was to (a) examine demographic, psychosocial, and physiological predictors of exercise adherence in a yearlong exercise intervention and (b) describe the trajectory of adherence over time. Participants were 51 men and 49 women aged 40-75 years. The supervised- and home-based intervention consisted of 60 minutes/day, 6 days/week of moderate-to-vigorous intensity exercise. Three adherence measures were used: (a) minutes/week, (b) MET-hours/week, and (c) change in cardiopulmonary fitness (VO2max). Predictors of adherence were determined separately by sex using mixed models and multivariable regression. Participants performed 287 ± 98 minutes/week of moderate-to-vigorous activity with 71% adhering to at least 80% (288 minutes/week) of the prescription. Men adhered better than women (p<.001). Among women, adiposity-related variables were significantly related to poorer adherence on all three measures (p<.05). A less consistent pattern was observed among men but in follow-up analyses, adiposity was associated with fewer MET-hours/week of exercise. Social support, pain, and perceived benefits were predictive in some models. Men and non-obese women experienced peak adherence at 4-6 months, while obese women peaked during months 0-3. When provided with supervision and support, previously sedentary men and women can achieve and maintain high levels of aerobic activity.
    Journal of Physical Activity and Health 10/2013; 11(7). DOI:10.1123/jpah.2012-0258 · 1.95 Impact Factor
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    ABSTRACT: Bone mineral density (BMD) and lean mass (LM) may both decrease in breast cancer survivors, thereby increasing risk of falls and fractures. Research is needed to determine whether lean mass (LM) and fat mass (FM) independently relate to BMD in this patient group. The Health, Eating, Activity, and Lifestyle Study participants included 599 women, ages 29--87 years, diagnosed from 1995--1999 with stage 0-IIIA breast cancer, who underwent dual-energy X-ray absorptiometry scans approximately 6-months postdiagnosis. We calculated adjusted geometric means of total body BMD within quartiles (Q) of LM and FM. We also stratified LM-BMD associations by a fat mass index threshold that tracks with obesity (lower body fat: <=12.9 kg/m2; higher body fat: >12.9 kg/m2) and stratified FM-BMD associations by appendicular lean mass index level corresponding with sarcopenia (non-sarcopenic: >=5.45 kg/m2 and sarcopenic: <5.45 kg/m2). Higher LM (Q4 vs. Q1) was associated with higher total body BMD overall (1.12 g/cm2 vs. 1.07 g/cm2, p-trend < 0.0001), and among survivors with lower body fat (1.13 g/cm2 vs. 1.07 g/cm2, p-trend < 0.0001) and higher body fat (1.15 g/cm2 vs. 1.08 g/cm2, p-trend = 0.004). Higher FM (Q4 vs. Q1) was associated with higher total body BMD overall (1.12 g/cm2 vs. 1.07 g/cm2, p-trend < 0.0001) and among non-sarcopenic survivors (1.15 g/cm2 vs. 1.08 g/cm2, p < 0.0001), but the association was not significant among sarcopenic survivors (1.09 g/cm2 vs. 1.04 g/cm2, p-trend = 0.18). Among breast cancer survivors, higher LM and FM were independently related to higher total body BMD. Future exercise interventions to prevent bone loss among survivors should consider the potential relevance of increasing and preserving LM.
    BMC Cancer 10/2013; 13(1):497. DOI:10.1186/1471-2407-13-497 · 3.36 Impact Factor
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    ABSTRACT: To determine the effectiveness of weight loss intervention for breast cancer survivors. From October 2012 until March 2013, Pubmed was searched for weight loss intervention trials that reported body weight or weight loss as a primary outcome. Fifteen of these studies are included in this review. Of the 15 studies included, 14 resulted in statistically significant weight loss and 10 obtained clinically meaningful weight loss of ≥5 % from baseline. Evidence was provided of the feasibility of using several methods of weight loss intervention (telephone, in person, individual, group). Successful intervention used a comprehensive approach, with dietary, physical activity, and behavior modification components. Weight loss improved cardiovascular risk factors and markers of glucose homeostasis. However, there is insufficient evidence to identify the components of this intervention that led to successful weight loss, or to determine the weight loss necessary to affect biomarkers linked to breast cancer prognosis. The small number of randomized controlled trials shared several limitations, including small study sample sizes and lack of follow-up beyond 6 months. Intervention with longer follow-up revealed weight regain, showing the importance of considering strategies to promote long-term weight maintenance. Weight loss intervention for breast cancer survivors can lead to statistically significant and clinically meaningful weight loss, but the limited number of interventional studies, small sample sizes, and short duration of follow-up in many studies limit our ability to draw conclusions regarding the most efficacious weight-loss intervention after a breast cancer diagnosis. The findings to date are encouraging, but research on the effect of weight loss on breast cancer recurrence and mortality, and on prevention of weight gain for women newly diagnosed with breast cancer, is needed.
    Current Breast Cancer Reports 09/2013; 5(3). DOI:10.1007/s12609-013-0113-0
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    ABSTRACT: Higher self-reported physical activity is associated with lower breast cancer incidence and mortality. Objectively measured timed walking speed, predictive of longevity in older adults, has been associated with ambulatory physical activity in small studies but definitive assessment of the association is lacking. Participants were a subset of 14 719 postmenopausal women in the Women's Health Initiative study who, at entry, had 10 m, timed walking speed determined. After 12.4 years [mean (SD) (3.5)] follow-up, 762 invasive breast cancers were diagnosed in this group. In addition, 8162 of these women self-reported physical activity. Simple linear regression was used to examine the relationship between timed walking speed and self-reported physical activity. A Cox proportional hazard model was used to estimate age-adjusted hazard ratios and 95% confidence intervals for the association between timed walking speed and invasive breast cancer incidence. Although a linear regression model for self-reported physical activity [log metabolic equivalent task (MET) h/week] versus 10 m, timed walking speed had a statistically significant slope (coefficient=0.03, P<0.0001, correlation=0.20), the magnitude of the relationship was not clinically useful. Timed walking speed quintile was not associated with breast cancer incidence in age-adjusted or multivariant analyses (P for trend=0.60). Timed walking speed was not associated with self-reported physical activity in a clinically useful manner or with breast cancer incidence. Our findings do not support use of timed walking speed as an objective surrogate for self-reported physical activity.
    European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 05/2013; 23(1). DOI:10.1097/CEJ.0b013e328361627e · 3.03 Impact Factor
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    ABSTRACT: Background: Many cancer survivors experience declines in health-related quality of life (HRQOL) and increases in fatigue as a result of cancer and its treatment. Exercise is linked to improvements in these outcomes, but little is known about the role of sedentary behavior. In a large, ethnically-diverse cohort of breast cancer survivors, we examined the relationship between sedentary time, HRQOL, and fatigue, and examined if that relationship differed by recreational moderate-vigorous physical activity (MVPA) level. Methods: Participants were 710 women diagnosed with stage 0-IIIA breast cancer in the Health, Eating, Activity, and Lifestyle Study. Women completed questionnaires at approximately 30-months postdiagnosis (sedentary time; recreational MVPA) and 41-months postdiagnosis (HRQOL; fatigue). In multivariate models, we regressed these outcomes linearly on quartiles of daily sedentary time, and a variable jointly reflecting sedentary time quartiles and MVPA categories (0; >0 to <9; ≥9 MET-hrs/wk). Results: Sedentary time was not independently related to subscales or summary scores of HRQOL or fatigue. In addition, comparisons of women with high vs. low (Q4:Q1) sedentary time by MVPA level did not result in significant differences in HRQOL or fatigue. Conclusion: In this breast cancer survivor cohort, self-reported sedentary time was not associated with HRQOL or fatigue, 3.5 years postdiagnosis.
    Journal of Physical Activity and Health 03/2013; 10(3):350-8. · 1.95 Impact Factor
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    ABSTRACT: Purpose: Recognition of the complex, multidimensional relationship between excess adiposity and cancer control outcomes has motivated the scientific community to seek new research models and paradigms. Methods: The National Cancer Institute developed an innovative concept to establish a center grant mechanism in nutrition, energetics, and physical activity, referred to as the Transdisciplinary Research on Energetics and Cancer (TREC) Initiative. This paper gives an overview of the 2011-2016 TREC Collaborative Network and the 15 research projects being conducted at the centers. Results: Four academic institutions were awarded TREC center grants in 2011: Harvard University, University of California San Diego, University of Pennsylvania, and Washington University in St. Louis. The Fred Hutchinson Cancer Research Center is the Coordination Center. The TREC research portfolio includes three animal studies, three cohort studies, four randomized clinical trials, one cross-sectional study, and two modeling studies. Disciplines represented by TREC investigators include basic science, endocrinology, epidemiology, biostatistics, behavior, medicine, nutrition, physical activity, genetics, engineering, health economics, and computer science. Approximately 41,000 participants will be involved in these studies, including children, healthy adults, and breast and prostate cancer survivors. Outcomes include biomarkers of cancer risk, changes in weight and physical activity, persistent adverse treatment effects (e.g., lymphedema, urinary and sexual function), and breast and prostate cancer mortality. Conclusion: The NIH Science of Team Science group will evaluate the value added by this collaborative science. However, the most important outcome will be whether this transdisciplinary initiative improves the health of Americans at risk of cancer as well as cancer survivors.
    Cancer Causes and Control 02/2013; 24(4). DOI:10.1007/s10552-013-0150-z · 2.74 Impact Factor
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    ABSTRACT: PURPOSE: Sedentary time is a rapidly emerging independent risk factor for mortality in the general population, but its prognostic effect among cancer survivors is unknown. In a multiethnic, prospective cohort of breast cancer survivors, we hypothesized that television watching time would be independently associated with an increased risk of death from any cause. METHODS: The Health, Eating, Activity, and Lifestyle Study cohort included 687 women diagnosed with local or regional breast cancer. On average 30 (±4) months postdiagnosis, women completed self-report assessments on time spent sitting watching television/videos in a typical day in the previous year. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for death from any cause (n = 89) during the 7 years of follow-up. RESULTS: Television time (top tertile vs. bottom tertile) was positively related to risk of death (HR, 1.94; 95 % CI, 1.02, 3.66, p (trend) = 0.024), but the association was attenuated and not statistically significant after adjustment for aerobic moderate-vigorous intensity physical activity (HR, 1.70; 95 % CI, 0.89, 3.22, p (trend) = 0.14) and all covariates (HR, 1.39; 95 % CI, 0.69, 2.82, p (trend) = 0.48). CONCLUSION: In this first published investigation on this topic, we did not observe a statistically significant multivariate-adjusted association between television watching time and risk of death among women diagnosed with breast cancer. IMPLICATIONS FOR CANCER SURVIVORS: These results begin an evidence base on this topic that can be built upon to inform lifestyle recommendations for this expanding, aging population.
    Journal of Cancer Survivorship 02/2013; 7(2). DOI:10.1007/s11764-013-0265-y · 3.30 Impact Factor

Publication Stats

10k Citations
746.93 Total Impact Points


  • 2003–2015
    • Yale University
      New Haven, Connecticut, United States
  • 2002–2014
    • Yale-New Haven Hospital
      • Department of Pathology
      New Haven, Connecticut, United States
  • 2013
    • National Cancer Institute (USA)
      • Division of Cancer Control and Population Sciences
      Bethesda, MD, United States
  • 2000–2011
    • Fred Hutchinson Cancer Research Center
      • • Division of Public Health Sciences
      • • Prevention Center
      Seattle, Washington, United States
  • 2010
    • The University of Calgary
      Calgary, Alberta, Canada
  • 2005
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2001
    • Salt Lake City Community College
      Salt Lake City, Utah, United States
  • 1998–2001
    • University of South Carolina
      • • Department of Exercise Science
      • • Department of Epidemiology & Biostatistics
      Columbia, SC, United States