Identifying the health- and nutrition-related needs of cancer caregivers.
It's difficult to overstate the importance of developing caregiver capacity. Because cancer survival rates have improved over the past two decades, more care is offered on an outpatient basis and, consequently, performed at home. As a result, caregivers have become instrumental in the recovery process. These important, yet time-consuming tasks can disrupt caregivers'; own self-care practices, and can result in overweight and obesity, and increase the individuals' risk for cancer that have been associated with excess weight.
The objective of this study is to identify and explore nutrition-related beliefs, behaviors, and challenges to maintaining a healthy diet among both caregivers and the loved ones they assist. In this research I am focusing on identifying the drivers of healthful dietary practices to assess how needs for nutrition support evolve across the treatment trajectory. In a sequential mixed methods design, we'll be assessing how caregivers' perceptions of competency in providing care for their loved ones, and, also, their health-related quality of life. To this end, we're conducting in-depth interviews to elucidate supportive care needs, and dietary assessments to identify drivers of high quality diets.
By understanding nutrition-related behaviors and how to enhance them in caregivers, we will have foundation knowledge to develop and test interventions that improve caregivers' nutrition and long-term health, increase their capacity to provide high-quality care, and benefit the nutrition of those who receive care through changes in dietary intake at the household level.
Collaboration with Thomas Jefferson University's Sidney Kimmel Cancer Center (SKCC).
Funded by the SKCC Transdisciplinary Integrated Population Science (TIPS) Pilot Project Grants program.
Improving healthy cancer survivorship by understanding nutrition-related beliefs, behaviors, and challenges.
Overweight individuals have an increased risk for developing cancer and a reduced rate of survival for certain cancers, including cancers of the breast, prostate, colon, and pancreas. Diet matters for both groups. For example, increasing consumption of fruits, vegetables, whole grains, nuts and consuming seafood, all have demonstrated beneficial effects. Despite the evidence suggesting the benefits of high dietary quality and healthful behaviors for cancer survivors, many do not adhere to the relevant behavioral recommendations.
Programs to help individuals with cancer and their caregivers address nutrition-related behaviors must reflect the needs, interests, and preferences of these unique populations. Therefore, the short-term goal in conducting this research was to characterize nutrition-related beliefs, experiences, behaviors and nutrition-related treatment side effects among individuals with cancer and their caregivers. This type of formative research is a critical step in development of effective nutrition interventions. Additionally, we identified preferences, barriers, and facilitators of engagement in lifestyle modification strategies. Using a convergent mixed methods study design, study activities include structured data collection and in-depth interviews.
Collaboration with University of the Sciences and American Cancer Society's Hope Lodge.
Funded by the Pennsylvania Department of Health.
Nutrition Assessment among Men Undergoing Genetic Counseling for Inherited Prostate Cancer: Exploring a Teachable Moment
In collaboration with Thomas Jefferson University's Department of Medical Oncology, we recently investigated whether men diagnosed with prostate cancer (PCA) and men at high risk for PCA who have undergone genetic counseling and testing in the Genetic Evaluation of Men study (PI: Veda Giri, MD), were meeting dietary and physical activity recommendations. The majority of these men were obese. Men with aggressive PCA reported consuming a diet with few vegetables and high amounts of red meat. In this research, we identified dietary and physical activity practices for lifestyle intervention programs for these individuals who were at high-risk.
Collaboration with Cancer Risk Assessment and Clinical Cancer Genetics Program, Department of Medical Oncology, Sidney Kimmel Cancer Center (SKCC), Thomas Jefferson University.
Heart Healthy Cooking Lab: Youth exploring wellness through cooking and gardening
In Philadelphia, more than 40% of children between the ages of 6 and 17 years qualify as overweight or obese. Poor diet and lack of physical activity are the most significant, modifiable behaviors that lead to inappropriate weight gain in children. The number of children in Philadelphia who meet dietary recommendations is below most US averages, with only 11.6% meeting fruit and vegetable recommendations.
One promising strategy to improve dietary intake and wellness among children is through cooking and garden-based education in the after-school setting.
The overall objective of this research is to test the effect of augmenting a culinary skills program (Vetri Cooking Lab) with garden-based education (Farm Explorer) using a quasi-experimental matched-controlled trial design. The intervention program focuses on strengthening children's understanding of the connection between healthful eating, growing, cooking and wellness and epitomizes community partnership in research. Here, we'll measure the effect of the program on nutrition-related knowledge, outcome expectations, and cooking self-efficacy, important precursors to long-term behavior change. This project is a collaboration between Drexel, Vetri Community Partnership, and Greener Partners, and illustrates the wide-ranging utility of gardens in health education.
Collaboration with Vetri Community Partnership and Greener Partners.
Funded by Drexel University's College of Nursing and Health Professions.
OpenSpace Rx: Improving our city's open spaces through community engagement
Physical, emotional, cognitive and social benefits are directly associated with the amount of time people spend in nature. However, the relationship between spending time in nature and dietary quality and diversity remains to be explored. In a multicomponent study funded by the William Penn Foundation, I am leading an investigation to explore the relationships between time spent in nature and in green spaces and the quality and diversity of dietary intake. In this study, my research team and I surveyed nearly 500 residents of Philadelphia and are currently analyzing the data. My goal in this research and in future inquiry is to elucidate the methods and mechanisms by which exposure to nature influences and improves dietary quality and diversity.
Collaboration with Drexel Watershed Consortium and Drexel College of Engineering.
Funded by William Penn Foundation.
Formative research on infant and young child feeding and maternal nutrition in Tajikistan
Tajikistan, a small and mountainous former Soviet country in Central Asia, is the poorest nation in the region and malnutrition is a significant health problem.
UNICEF Tajikistan partnered with the Tajikistan Ministry of Health and Social Protection (MoHSP) and Drexel University (PI Ann Klassen, PhD), to conduct formative research to explore socio-cultural, economic, gender, and contextual determinants of infant and young child feeding and maternal nutrition practices in Tajikistan. This work also provided us with an opportunity for innovation in instrument development, leading to the creation of a tool that can be used in the systematic evaluation of the food environment in bazaars.
Collaboration with Drexel's Dornsife School of Public Healther
Funded by UNICEF Tajikistan.
Links for Publications
Paek MS, Nightingale C, Tooze JA, Milliron BJ, Weaver K, Sterba K. Contextual and stress process factors associated with head and neck cancer caregivers' physical and psychological well-being. European Journal of Cancer Care. 2018; [EPub ahead of print].
Petroka K, Campbell-Bussiere R, Dychtwald DK, Milliron BJ. Barriers and facilitators to healthy eating and disease self-management among older adults residing in subsidized housing. Journal of Nutrition and Health. 2017; [Epub ahead of print].
Milliron BJ, Vitolins M, Gamble E, Jones R, Chenault MC, Tooze J. Process evaluation of a community garden at an urban outpatient clinic. Journal of Community Health. 2017;42(4):639-648.
Volpe SL, Sukumar D, Milliron BJ. Obesity prevention in older adults. Current Obesity Reports. 2016;5(2):166-75.
Nightingale C, Sterba K, Tooze J, Milliron BJ, Tetrick L, Paek MS, Weaver K. Vulnerable characteristics and interest in wellness programs among head and neck cancer caregivers. Supportive Care in Cancer. 2016;24(8):3437-45.
Thomas L, Milliron BJ, Heller J, Woolf K. Lifestyle behaviors affecting bone health in young Hispanic and non-Hispanic white women. Topics in Clinical Nutrition. 2016; 31(1). 24-35.
Deutsch J, Milliron BJ. Food Safety Microlessons. NYC Department of Health and Mental Hygiene. 2016.
Vitolins M, Milliron BJ, Hopkins J, Fulmer A, Case D. Use of a meal replacement weight loss intervention in survivors of ER/PR-negative breast cancer. Clinical Medical Insights: Women's Health. 2014; 16(7):17-24. doi: 10.4137/CMWH.S13955.
Vitolins M, Milliron BJ, Hopkins J, Fulmer A, Case D. Use of meal replacement weight loss intervention in survivors of ER/PR-negative breast cancer. Clinical Medical Insights: Women's Health. 2014; 16(7):17-24. doi: 10.4137CMWH.S13955
Huang KE, Milliron BJ, Davis SA, Feldman SR. Surge in US outpatient vitamin D deficiency diagnosis: National Ambulatory Medical Care Survey analysis. South Medical Journal. 2014; 107(4): 45. doi: 10.1197/SMJ.000000 0000000085.
Koohkan S, Schaffner D, Milliron BJ, Frey I, Konig D, Deibert P, Vitolins M, Berg A. Impact of a weight reduction program on health related quality of life (HRQOL) in middle-aged obese females. BMC Womens Health. 2014; 14(1): 45. doi: 10.1186/1472-6874-14-15.
Milliron BJ, Vitolins M, Tooze J. Usual dietary intake among female breast cancer survivors compared to women with no cancer history: findings from NHANES (2003-2006). Journal of the Academy of Nutrition and Dietetics. 2014; 114(6): 932-937. doi: 10.1016/j.jand.2013.08.015.
Al-Dabagh A, Milliron BJ, Strowd L, Feldman SR. A disease of the present: two cases of scurvy in “well-nourished” patients. Journal of the American Academy of Dermatology. 2013; 69(5):e:246-7. doi: 10.1016/j.jaad.2013.04.0 51.
Miller S, Milliron BJ, Woolf K. Common prediction equations overestimate measured resting metabolic rate in young Hispanic women. Topics in Clinical Nutrition. 2013; 28(2): 120-135.
Milliron BJ, Woolf K, Appelhans B. A point-of-purchase intervention featuring in-person supermarket education impacts healthy food purchases. Journal of Nutrition Education and Behavior. 2013; 44(3):225-32. doi: 10.1016/j.jneb.201 1.05.016.
Appelhans B, Milliron BJ, Woolf K, Johnson T, Pagoto S, Schneider K, Whited M, Ventrelle J. Socioeconomic status, energy cost, and the nutrient content of supermarket food purchases. American Journal of Preventive Medicine, 2012; 42(4), 398-402. doi: 10.1016/j.amepre.2011.12.007.
Milliron BJ, Woolf K, Ruhs B, Appelhans BA. Academics in the Aisles: Establishing a University-Supermarket Partnership for Healthy Shopping. Gateways: International Journal of Community Research and Engagement. 2012; 5:183-91.
Grimstvedt M, Woolf K, Milliron BJ, Manore M. Lower Healthy Eating Index-2005 dietary quality scores in older women with rheumatoid arthritis v. healthy controls. Journal of Public Health Nutrition. 2010;13(8), 1170-7. doi: 10.1017/S136898001000 008X.
Selected Refereed Presentations
Milliron BJ, Dychtwald DK, Deutsch J, Zeng Y, Sy K, Barksdale B, Ogbogu O, Packel L. Nutrition-related beliefs, behaviors and needs among individuals with cancer and their caregivers. Society for Nutrition Education and Behavior Annual Meeting, July 2018. Minneapolis, MN.
Milliron BJ, Dychtwald DK, Deutsch J, Zeng Y, Sy K, Barksdale B, Ogbogu O, Packel L. Treatment-related dietary changes and management of nutrition-related treatment side effects: Experiences and perspectives of individuals with cancer and their caregivers. American Society of Clinical Oncology Annual Conference, Chicago, IL. June 2018.
Giri V, Bruneau M, Obeid E, Smaltz C, Milliron BJ. Nutrition assessment among men undergoing genetic counseling for inherited prostate cancer: A teachable moment. American Society of Clinical Oncology Annual Conference, Chicago, IL. June 2018.
Sinclair E, Giri V, Milliron BJ, Obeid E, Smaltz C, Bruneau M. Physical activity assessment among men undergoing genetic counseling for inherited prostate cancer: A teachable moment. Drexel University Pennoni Honors College Week of Undergraduate Excellence, Philadelphia, PA, May 2018.
Werner EN, Smith SA, Mesinger J, Milliron BJ, Betz HH, Volpe SL. Antioxidant intake, adiposity, and aerobic capacity in an athlete population. American College of Sports Medicine National Conference. May 2018. (poster)
Zeng Y, Booth M, Nadel H, Bruneau M, Volpe S, Milliron BJ. Evaluation of Heart Healthy Cooking Lab: Youth exploring wellness through cooking and gardening. Drexel University Emerging Scholars Symposium. April 2018. Philadelphia, PA.
Conery K, Hanna M, Morgan A, Dychtwald DK, Deutsch J, Zeng Y, Sy K, Barksdale B, Ogbogu O, Milliron BJ, Packel L. Exercise beliefs, behaviors, and attitudes in low-income cancer caregivers: A needs assessment. University of the Sciences Scholarly Symposium. April 2018. Philadelphia, PA.
Milliron BJ, Chenault M-C, Abduzhalilov R, Grossman S, Leonberg B, Klasson AC. Accessibility of key foods for infant and young child feeding and maternal health in Tajikistan. American Public Health Association Annual Meeting, November 2017. Atlanta, GA.
Deutsch J, Fulton B, Zeitz A, Milliron BJ, Bartoli C. Implementing Philadelphia's Nutrition Standards: Using Partnerships to Reformulate Recipes and Food Products Cost-Effectively, in Thottathil, S.E. and Goger, A.M., Eds.Institutional Foodservice Purchasing as a Lever for Change, Elsevier, Expected Publication Summer/Fall 2018.
Milliron BJ, Chenault MC, Dychtwald D. (2017). Intervening to change the public's eating behavior. Chapter in Nutrition in Public Health. Edelstein S (ed).
Dardarian N, Milliron BJ, Bateman D. (2015). Sex and gender differences in sports nutrition. Chapter in Gender and Sex Differences in Sports Medicine.
Milliron BJ, Woolf K. (2011). Lower dietary quality among women who watch more television: findings in support of the Dietary Guidelines for Americans. Chapter in Advances in Medicine and Biology. Berhardt LV (ed). Volume 34.
Milliron BJ, Woolf K, Appelhans B. (2011). Dietary intake during screen time among premenopausal women. Chapter in Sedentary Behaviors: Physiology, health risks, and interventions. Bergin MG (ed). pp. 63-80.