Michael J LaMonte

State University of New York, New York, New York, United States

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Publications (152)762.98 Total impact

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    ABSTRACT: Purpose of the Study: Women’s military roles, exposures, and associated health outcomes have changed over time. However, mortality risk—within military generations or compared with non-Veteran women—has not been assessed. Using data from the Women’s Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women. Design and Methods: WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation. Results: After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09–1.23) for pre-Vietnam and 1.16 (95% CI: 0.99–1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64–5.23). Implications: Veterans’ higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed.
    Full-text · Article · Feb 2016 · The Gerontologist
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    ABSTRACT: Purpose of the Study: Trajectories of physical activity (PA) and sedentary time (ST) after military separation are likely important determinants of women’s health outcomes later in life, because low PA and high ST are known contributors to premature mortality risk. Our objective was to compare longitudinal trajectories of recreational PA and ST between Veteran and non-Veteran postmenopausal women from the Women’s Health Initiative (WHI). Design and Methods: Women Veteran (n = 3,719) and non-Veteran (n = 141,800) WHI participants were included. Self-reported participation in recreational PA, converted to metabolic equivalent (MET)-hours/week, was prospectively assessed over 8 years. Self-reported ST, defined as hours/day sitting or lying down, was collected at baseline and at Years 3 and 6. Generalized estimating equations were used to compare trajectories of PA and ST between Veterans and non-Veterans, adjusted for demographics and lifestyle behaviors. Results: Veterans had higher baseline PA than non-Veterans (13.2 vs 12.5 MET-hours/week, p = .03). PA declined for both groups, with a steeper decline among Veterans (change/visit year −0.19 vs −0.02 MET-hours/week; interaction p < .001). At baseline, Veterans and non-Veterans had similar levels of ST (107.2 vs 105.9 hours/week, p = 0.42). Over time, ST remained stable among Veterans but declined slightly among non-Veterans (change/visit year −0.19 vs −0.49 hours/week; interaction p = .01). Implications: The less favorable longitudinal trajectories of PA and ST we observed for women Veterans may contribute to worse health among these individuals later in life. Understanding barriers to enhancing PA and reducing ST in women Veterans could lead to more effective approaches to intervening on these health behaviors.
    Full-text · Article · Feb 2016 · The Gerontologist
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    ABSTRACT: Purpose of the Study: To examine whether Veteran status influences (a) women’s survival to age 80 years without disease and disability and (b) indicators of successful, effective, and optimal aging at ages 80 years and older. Design and Methods: The Women’s Health Initiative (WHI) enrolled 161,808 postmenopausal women aged 50–79 years from 1993 to 1998. We compared successful aging indicators collected in 2011–2012 via mailed questionnaire among 33,565 women (921 Veterans) who reached the age of 80 years and older, according to Veteran status. A second analysis focused on women with intact mobility at baseline who could have reached age 80 years by December 2013. Multinominal logistic models examined Veteran status in relation to survival to age 80 years without major disease or mobility disability versus having prevalent or incident disease, having mobility disability, or dying prior to age 80 years. Results: Women Veterans aged 80 years and older reported significantly lower perceived health, physical function, life satisfaction, social support, quality of life, and purpose in life scale scores compared with non-Veterans. The largest difference was in physical function scores (53.0 for Veterans vs 59.5 for non-Veterans; p < .001). Women Veterans were significantly more likely to die prior to age 80 years than non-Veteran WHI participants (multivariate adjusted odds ratio = 1.20; 95% confidence interval, 1.04–1.38). In both Veteran and non-Veteran women, healthy survival was associated with not smoking, higher physical activity, healthy body weight, and fewer depressive symptoms. Implications: Intervening upon smoking, low physical activity, obesity, and depressive symptoms has potential to improve chances for healthy survival in older women including Veterans.
    Full-text · Article · Feb 2016 · The Gerontologist
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    ABSTRACT: Background: Periodontal disease has been consistently associated with chronic disease; there are no large studies of breast cancer, although oral-associated microbes are present in breast tumors. Methods: In the Women's Health Initiative Observational Study, a prospective cohort of postmenopausal women, 73,737 women without previous breast cancer were followed. Incident, primary, invasive breast tumors were verified by physician adjudication. Periodontal disease was by self-report. HRs and 95% confidence intervals (CI) were estimated by Cox proportional hazards, adjusted for breast cancer risk factors. Because the oral microbiome of those with periodontal disease differs with smoking status, we examined associations stratified by smoking. Results: 2,124 incident, invasive breast cancer cases were identified after mean follow-up of 6.7 years. Periodontal disease, reported by 26.1% of women, was associated with increased breast cancer risk (HR 1.14; 95% CI, 1.03-1.26), particularly among former smokers who quit within 20 years (HR 1.36; 95% CI, 1.05-1.77). Among current smokers, the trend was similar (HR 1.32; 95% CI, 0.83-2.11); there were few cases (n = 74) and the CI included the null. The population attributable fraction was 12.06% (95% CI, 1.12-21.79) and 10.90% (95% CI, 10.31-28.94) for periodontal disease among former smokers quitting within 20 years and current smokers, respectively. Conclusion: Periodontal disease, a common chronic inflammatory disorder, was associated with increased risk of postmenopausal breast cancer, particularly among former smokers who quit in the past 20 years. Impact: Understanding a possible role of the oral microbiome in breast carcinogenesis could impact prevention.
    No preview · Article · Dec 2015 · Cancer Epidemiology Biomarkers & Prevention
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    ABSTRACT: Purpose: Few prospective studies have reported on relationships between objective periodontal disease (PD) measures and cancer risk. This association was examined in 1,337 postmenopausal women participating in the Buffalo OsteoPerio Study. Methods: Oral alveolar crestal height (ACH) was measured using oral radiographs. Incident cancers were adjudicated with medical records. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for associations between ACH and incident cancer outcomes were estimated using Cox proportional hazards models. Results: There were 203 confirmed total incident cancer cases during follow-up (12.2 ± 4.2 years). After adjusting for age and smoking, there were no statistically significant associations between ACH-defined PD categories and total cancer risk (mild/moderate vs. none: HR 1.33, 95 % CI 0.91-1.94; severe vs. none: HR 1.20, 95 % CI 0.77-1.86). ACH-defined PD categories were not associated with common site-specific cancers. Whole-mouth mean and worst-site ACH (per 1 mm loss) were significantly associated with increased risk of lung (adjusted HR 1.81, 95 % CI 1.30-2.54; adjusted HR 1.34, 95 % CI 1.08-1.66, respectively), but not total or other site-specific cancer. Smoking status modified the associations between continuous ACH variables and total cancer risk; measures of PD were associated with total cancer among smokers but not never smokers (interaction p = 0.02 and p < 0.01 for whole-mouth mean and worst-site ACH, respectively). Conclusions: ACH-defined PD was associated with total cancer risk in ever but not never smoking postmenopausal women. Whole-mouth mean and worst-site ACH were associated with increased lung cancer risk. However, these results need to be interpreted cautiously given the small number of lung cancer cases (n = 18). Further research utilizing a larger sample is warranted to confirm the relationships among oral bone loss, site-specific cancers, and total cancer.
    No preview · Article · Dec 2015 · Cancer Causes and Control

  • No preview · Article · Dec 2015
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    ABSTRACT: Findings from studies of metformin use with risk of cancer incidence and outcome provide mixed results; with few studies examined associations by recency of diabetes diagnosis or duration of medication use. Thus, in the Women's Health Initiative, we examined these associations and further explored whether associations differ by recency of diabetes and duration of metformin use. Cox regression models were used to estimate hazard ratios (HR) and their 95% confidence intervals. Diabetes was associated with higher risk of total invasive cancer (HR, 1.13; p<0.001), and of several site-specific cancers (HR, 1.2-1.4, and up to over 2-fold). Diabetes was also associated with higher risk of death from cancer (HR, 1.46; p<0.001). There was no overall difference in cancer incidence by diabetes therapy (p=0.66). However, there was a lower risk of death from cancer for metformin users, compared to users of other medications, relative to women without diabetes, overall (HRs, 1.08 versus 1.45; p=0.007) and for breast cancer (HRs, 0.50 versus 1.29; p=0.05). Results also suggested that lower cancer risk associated with metformin may be evident only for a longer duration of use in certain cancer sites or subgroup populations. We provide further evidence that postmenopausal women with diabetes are at higher risk of invasive cancer and cancer death. Metformin users, particularly long-term users, may be at lower risk of developing certain cancers and dying from cancer, compared to users of other anti-diabetes medications. Future studies are needed to determine the long-term effect of metformin in cancer risk and survival from cancer. This article is protected by copyright. All rights reserved.
    No preview · Article · Nov 2015 · International Journal of Cancer
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    ABSTRACT: Background: Extra-oral translocation of oral bacteria may contribute to associations between periodontal disease and cancer. We investigated the associations among the presence of three orange-complex periodontal pathogens (Fusobacterium nucleatum, Prevotella intermedia, and Campylobacter rectus), two red-complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia) and cancer risk. Methods: We prospectively followed 1,252 postmenopausal women enrolled in the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) Study. Baseline subgingival plaque samples were assessed for presence of periodontal pathogens using indirect immunofluorescence. Incident cancer cases were adjudicated by staff physicians via review of medical records. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the associations of periodontal pathogens with total cancer and site-specific cancer risk in unadjusted as well as multivariable-adjusted models. Results: Neither the presence of individual pathogens nor the presence of any red-complex pathogens was associated with total cancer or with site-specific cancers. Borderline associations were seen among the presence of any orange-complex pathogens (Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus), total cancer risk (HR=1.35, 95% CI: 1.00-1.84), and lung cancer risk (HR=3.02, 95% CI: 0.98-9.29). Conclusions: No associations were found between the presence of individual subgingival pathogens and cancer risk. However, there were suggestions of borderline positive associations of the presence of any orange-complex pathogens with total cancer and lung cancer risk. The study was limited by the small number of cancer cases and the assessment of only five oral bacteria. Additional research is needed to understand the possible role of periodontal disease in carcinogenesis.
    No preview · Article · Oct 2015 · Journal of Periodontology
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    ABSTRACT: Background: The health of postmenopausal women veterans is a neglected area of study. A stronger empirical evidence base is needed, and would inform the provision of health care for the nearly 1 million U.S. women veterans currently 50 years of age or older. To this end, the present work compares salient health outcomes and risk of all-cause mortality among veteran and non-veteran participants of the Women's Health Initiative (WHI). Methods: This study features prospective analysis of long-term health outcomes and mortality risk (average follow-up, 8 years) among the 3,706 women veterans and 141,009 non-veterans who participated in the WHI Observational Study or Clinical Trials. Outcome measurements included confirmed incident cases of cardiovascular disease (CVD), cancer, diabetes, hip fractures, and all-cause mortality. Results: We identified 17,968 cases of CVD, 19,152 cases of cancer, 18,718 cases of diabetes, 2,817 cases of hip fracture, and 13,747 deaths. In Cox regression models adjusted for age, sociodemographic variables, and health risk factors, veteran status was associated with significantly increased risk of all-cause mortality (hazard ratio [HR], 1.13; 95% CI, 1.03-1.23), but not with risk of CVD (HR, 1.00; 95% CI, 0.90-1.11), cancer (HR, 1.04; 95% CI, 0.95-1.14), hip fracture (HR, 1.16; 95% CI, 0.94-1.43), or diabetes (HR, 1.00; 95% CI, 0.89-1.1). Conclusions: Women veterans' postmenopausal health, particularly risk for all-cause mortality, warrants further consideration. In particular, efforts to identify and address modifiable risk factors associated with all-cause mortality are needed.
    Full-text · Article · Oct 2015 · Women s Health Issues

  • No preview · Article · Sep 2015
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    ABSTRACT: Objective: We conducted a laboratory-based calibration study to determine relevant cutpoints for a hip-worn accelerometer among women ≥60 years, considering both type and filtering of counts. Methods: Two hundred women wore an ActiGraph GT3X+ accelerometer on their hip while performing eight laboratory-based activities. Oxygen uptake was measured using an Oxycon portable calorimeter. Accelerometer data were analyzed in 15-second epochs for both normal and low frequency extension (LFE) filters. Receiver operating characteristic (ROC) curve analyses were used to calculate cutpoints for sedentary, light (low and high), and moderate to vigorous physical activity (MVPA) using the vertical axis and vector magnitude (VM) counts. Results: Mean age was 75.5 years (standard deviation 7.7). The Spearman correlation between oxygen uptake and accelerometry ranged from 0.77 to 0.85 for the normal and LFE filters and for both the vertical axis and VM. The area under the ROC curve was generally higher for VM compared to the vertical axis, and higher for cutpoints distinguishing MVPA compared to sedentary and light low activities. The VM better discriminated sedentary from light low activities compared to the vertical axis. The area under the ROC curves were better for the LFE filter compared to the normal filter for the vertical axis counts, but no meaningful differences were found by filter type for VM counts. Conclusion: The cutpoints derived for this study among women ≥60 years can be applied to ongoing epidemiologic studies to define a range of physical activity intensities.
    Preview · Article · Sep 2015

  • No preview · Article · Aug 2015 · Cancer Research
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    ABSTRACT: Chronic inflammation may increase risk of fracture and omega-3 polyunsaturated fatty acids (PUFA) may reduce fracture risk via down regulation of inflammatory cytokine gene expression and other mechanisms. We investigated associations between baseline samples of inflammatory markers, tumor necrosis factor α soluble receptors 1 and 2 (TNFα-sR1 and sR2) and incident hip fracture. These associations were then tested for effect modification by dietary PUFA intake estimated by baseline food frequency questionnaire. A nested case-control study was conducted among participants of the Women's Health Initiative Observational Study (ages 50-79). Multivariable conditional logistic regression models were constructed to account for the paired design. This study sampled 400 pairs of hip fracture cases and controls without incident hip fracture, matched on age, year of enrollment, and menopausal hormone use. Odds ratio (OR) of hip fracture by quartile of TNF soluble receptors Results: OR of hip fracture comparing the highest to lowest quartile was 2.24 (95% confidence interval [CI], 1.05-4.79; p for linear trend 0.048) for TNFα-sR1 and 2.83 (95% CI, 1.34-5.99; p for linear trend 0.011) for TNFα-sR2, adjusted for FRAX hip fracture score, nutritional variables and selected factors impacting inflammation; there was a gradient of risk by increasing quartile in TNFα-sR1. PUFA intake did not modify these associations. Women with the highest levels of TNFα-sR1 and TNFα-sR2 had greater than two-fold increased hip fracture risk, independent of other fracture risk factors. These associations did not differ by high versus low PUFA intake.
    No preview · Article · Jul 2015 · The Journal of Clinical Endocrinology and Metabolism
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    ABSTRACT: Background: Declines in endogenous estrogen levels after menopause can lead to systemic bone loss, including loss of oral bone and alveolar crest height (ACH). However, few studies have assessed both serum 17β-estradiol (E2) and exogenous hormone therapy (HT) use in relation to oral bone loss. Methods: This study examines the associations among serum E2, HT use, and ACH in 613 postmenopausal women from the Buffalo OsteoPerio study. Baseline ACH levels and 5-year ACH were assessed for groups according to E2 level (undetectable, >5.00 to ≤18.00, >18.00 to ≤46.07, and >46.07 pg/mL) and among HT use (never, ever) using analysis of variance and analysis of covariance. Logistic regression was used to analyze the association of ACH loss with serum E2 and HT use. Results: In cross-sectional analyses, no association was found of serum E2 with whole-mouth mean or worst-site ACH. However, history of HT use was associated with ACH. Women who had never used HT had more ACH loss assessed as a whole-mouth mean ACH (P = 0.01) and as worst-site ACH loss (P = 0.03). In logistic regression analyses of baseline ACH loss severity, HT never-users had two-fold higher odds of being in the severe ACH loss category compared to ever-users (odds ratio, 2.00; 95% confidence interval, 1.11 to 3.62). No association was observed of 5-year change in ACH with baseline serum E2 or HT use. Conclusion: Although this study did not detect an association with current serum E2 level and ACH, HT use was found to be associated with less ACH loss in postmenopausal women.
    Full-text · Article · Jan 2015 · Journal of Periodontology
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    ABSTRACT: INTRODUCTION: Obesity is a major risk factor for physical disability in older adults. The contribution of early onset of obesity and weight history to physical impairment later in life remains inconclusive. METHODS: Postmenopausal women (n=76,016, 63.5 ± 7.3 years) recalled weight and height at ages 18, 35, 50 years and reported it at their baseline measurement. Standard body mass index (BMI=kg/m2) categories were used to evaluate associations between early onset obesity and weight transitions on severe physical impairment (SPI), defined as scoring < 60 on the Rand 36-Item Health survey. RESULTS: Women reporting being overweight or obese at 18 years had a higher likelihood of SPI (1.48, 95% Confidence Interval (CI): 1.32-1.65; and 2.07, 95% CI: 1.66-2.58, respectively) than normal weight counterparts. Weight changes from normal to high (overweight/obese) or underweight BMI’s yielded higher SPI rates [1.98 (1.82-2.12) and 1.34 (1.07-1.70), respectively] compared to women who remained weight stable. Women shifting from underweight to high BMI’s were more likely to have SPI [1.57 (1.15-2.14)]. High to normal BMI transitions resulted in a lower SPI rate [0.52 (0.39-0.70)]. Results were adjusted for demographics, behaviors, comorbidities and medications. DISCUSSION: Obesity in early adulthood was associated with higher severe physical impairment rates later in life. Weight transitions toward being underweight, overweight or obese also increased the risk of SPI. In contrast, overweight women who lost weight over their lifetime show reduced risk of impairment. Maintenance of a healthy body weight throughout life is important for reducing risk of physical impairment.
    No preview · Conference Paper · Nov 2014
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    ABSTRACT: Objectives: We evaluated the association between childhood physical activity and incident cardiovascular disease (CVD) during the postmenopausal years. Methods: Proportional hazards and logistic regression were used to describe the association between self-reported childhood physical activity and CVD incidence and mortality in 36,741 postmenopausal women. Results: Older women, African Americans, and nondrinkers or past drinkers self-reported the highest levels of youth physical activity and women with a history of diabetes, hypertension, overweight or obesity, or current smoking reported the highest youth physical activity dose. Youth physical activity was not associated with CVD incidence (HR=1.11; 0.93, 1.34) or mortality (HR=1.2; 0.9, 1.73). Conclusions: Self-reported youth activity was not associated with postmenopausal CVD incidence or mortality.
    No preview · Article · Nov 2014

  • No preview · Article · Oct 2014 · Cancer Research

  • No preview · Article · Oct 2014
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    ABSTRACT: Background: Healthy levels of lifestyle factors can reduce the risk of cardiovascular disease. However, except for smoking status, often considered a traditional risk factor, their effect on cardiovascular risk prediction is unclear. Methods and results: We used a case-cohort design of postmenopausal nonsmokers in the multiethnic Women's Health Initiative Observational Study (1587 cases and 1808 subcohort participants) with a median follow-up of 10 years in noncases. Compared with nonsmokers with no other healthy lifestyle factors (healthy diet, recreational physical activity, moderate alcohol use, and low adiposity), the risk of cardiovascular disease was lower for each additional factor (hazard ratio for trend, 0.82; 95% confidence interval, 0.76-0.89), with a 45% reduction in risk with all factors (95% confidence interval, 0.36-0.84). When lifestyle factors were added to traditional risk factor models (variables from the Pooled Cohort and Reynolds risk scores), only recreational physical activity remained independently associated with the risk of cardiovascular disease. The addition of detailed lifestyle measures to traditional models showed a change in the integrated discrimination improvement and continuous net reclassification improvement (P<0.01 for both) but had little impact on more clinically relevant risk stratification measures. Conclusions: Although lifestyle factors have important effects on cardiovascular disease risk factors and subsequent risk, their addition to established cardiovascular disease risk models does not result in clear improvement in overall prediction.
    Preview · Article · Aug 2014 · Circulation
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    ABSTRACT: Objectives: Mean and visit-to-visit variability (VVV) of blood pressure (BP) are associated with an increased cardiovascular disease risk. We examined the effect of hormone therapy on mean and VVV of BP in postmenopausal women from the Women's Health Initiative (WHI) randomized controlled trials. Methods: BP was measured at baseline and annually in the two WHI hormone therapy trials, in which 10 739 and 16 608 postmenopausal women were randomized to conjugated equine estrogens (CEEs, 0.625 mg/day) or placebo, and CEEs and medroxyprogesterone acetate (MPA, 2.5 mg/day) or placebo, respectively. Results: At the first annual visit (year 1), mean SBP was 1.04 mmHg [95% confidence interval (CI) 0.58, 1.50] and 1.35 mmHg (95% CI 0.99, 1.72) higher in the CEEs and CEEs and MPA arms, respectively, compared with the corresponding placebos. These effects remained stable after year 1. CEEs also increased the VVV of SBP (ratio of VVV in CEEs vs. placebo, 1.03; P < 0.001), whereas CEEs and MPA did not (ratio of VVV in CEEs and MPA vs. placebo, 1.01; P = 0.20). After accounting for study drug adherence, the effects of CEEs and CEEs and MPA on mean SBP increased at year 1, and the differences in the CEEs and CEEs and MPA arms vs. placebos also continued to increase after year 1. Further, both CEEs and CEEs and MPA significantly increased the VVV of SBP (ratio of VVV in CEEs vs. placebo, 1.04; P < 0.001; ratio of VVV in CEEs and MPA vs. placebo, 1.05; P < 0.001). Conclusion: Among postmenopausal women, CEEs and CEEs and MPA at conventional doses increased mean and VVV of SBP.
    No preview · Article · Jul 2014 · Journal of Hypertension

Publication Stats

7k Citations
762.98 Total Impact Points


  • 2011-2015
    • State University of New York
      New York, New York, United States
  • 2007-2015
    • University at Buffalo, The State University of New York
      • • School of Public Health and Health Professions
      • • Department of Social and Preventive Medicine
      Buffalo, New York, United States
    • University of North Carolina at Chapel Hill
      North Carolina, United States
  • 2013
    • Fred Hutchinson Cancer Research Center
      • Division of Public Health Sciences
      Seattle, Washington, United States
  • 2010
    • SUNY Ulster
      Kingston, New York, United States
  • 2000-2007
    • University of South Carolina
      • • Department of Exercise Science
      • • Department of Epidemiology & Biostatistics
      • • Prevention Research Center
      Columbia, SC, United States
  • 2006
    • University of Hawaiʻi at Mānoa
      Honolulu, Hawaii, United States
  • 2005
    • University of Texas at Dallas
      Richardson, Texas, United States
    • Brigham Young University - Provo Main Campus
      • College of Health and Human Performance
      Provo, UT, United States
  • 2004
    • San Diego State University
      San Diego, California, United States
  • 2000-2004
    • University of Utah
      • Department of Exercise and Sport Science
      Salt Lake City, Utah, United States
  • 2002
    • University of North Carolina at Greensboro
      Greensboro, North Carolina, United States
  • 2001
    • Salt Lake City Community College
      Salt Lake City, Utah, United States