Nurses' Health Study

Last updated

The Nurses' Health Study is a series of prospective studies that examine epidemiology and the long-term effects of nutrition, hormones, environment, and nurses' work-life on health and disease development. [1] [2] The studies have been among the largest investigations into risk factors for major chronic diseases ever conducted. The Nurses' Health Studies have led to many insights on health and well-being, including cancer prevention, cardiovascular disease, and type 2 diabetes. [2] They have included clinicians, epidemiologists, and statisticians at the Channing Laboratory (of Brigham and Women's Hospital), Harvard Medical School, Harvard School of Public Health, and several Harvard-affiliated hospitals, including Brigham and Women's Hospital, Dana–Farber Cancer Institute, Children's Hospital Boston, and Beth Israel Deaconess Medical Center. [3]

Contents

Cohorts

Cohorts [4]
StudyYear PI Enrollees
Nurses' Health Study1976Frank Speizer121,700
Nurses' Health Study II1989 Walter Willett 116,430
Nurses' Health Study 32010Jorge Chavarrotarget: 100,000

The Nurses' Health Study original cohort was established in 1976 by Frank E. Speizer. [5] Initially, the study investigated contraceptive use, smoking, cancer, and cardiovascular disease. [6] The 1976 baseline group included married female registered nurses between the ages of 30 and 55. [6] Approximately 121,700 participants in 11 of the most populous U.S. states (California, Connecticut, Florida, Maryland, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, and Texas) responded. The survey was then distributed biennially thereafter. [6] Over the years, the principal investigator of the Nurses' Health Study have been Frank Speizer, Graham Colditz, Sue Hankinson, and Meir Stampfer. [7]

Over time, the study expanded. Most notably, a dietary questionnaire was added in 1980 due to investigators recognizing the impact of diet and nutrition on the development of chronic disease. Blood, urine, saliva, and other physical samples were received and tested beginning in 1982. [5] Experimenters followed up reports of morbidity using the National Death Index. [5] Where possible and permitted, cancer diagnoses were reviewed. [5] Although reports of other diseases were not followed up, self-reporting has been confirmed by medical records and doctors unaware of the answers to the study's questions. [5]

The Nurses' Health Study II was established in 1989 by Walter Willett, who has been its principal investigator since inception. The focus of the study was women's health, especially the long term adverse effects of oral contraceptives. [6] The sample population contained females within the age range of 25–42, employed as nurses, from 14 U.S. States. [5] Data collected included the brand of pill and length of use. [5] Over time, the study expanded to include information on basic practices and measurements of health, such as exercise practices and food intake. [5]

Between the years of 1996 and 1999, approximately 30,000 nurses volunteered to provide blood and urine samples to the study. [8] Of these women, 18,500 were pre-menopausal, providing samples at specific points in the menstrual cycle. [8] These data allowed researchers to study how hormone levels influence the risk of disease. A second set of samples was collected from 16,500 of the same group of women in 2010–2012, by which time most of them were postmenopausal. [8] Over 25,000 children of women in the Nurses' Health Study II cohort were enrolled in their own follow-up study called the Growing Up Today Study, or GUTS, which has followed the subjects through their early life so as to obtain a second generation of data. [9]

The Nurses' Health Study 3 was developed in 2010 by Drs. Jorge Chavarro, Walter Willett, Janet Rich-Edwards, and Stacey Missmer. [6] The study includes investigators from the Channing Division of Network Medicine at Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health. [1] The original population contained females 19–49 in age and expanded to include Canadian subjects. [5] Unlike the predecessor studies, the NH3 includes participants of both male and female genders in 2015. [5] Jorge Chavarro has been the principal investigator of Nurses' Health Study 3 since its 2010 inception. [5]

Findings

The studies revealed many correlations, that is statistical relationships, whether causal or not, between environmental factors and risk for health conditions.

Smoking: correlated to a higher likelihood of cardiovascular disease (CVD), [10] colorectal [11] and pancreatic [12] cancer, psoriasis, [13] multiple sclerosis, [14] type 2 diabetes, [15] and eye disease. [16]

Trans Fats: correlation between cardiovascular disease (CVD) and consumption of trans fatty acids. [17] Initially met with skepticism, [18] it ultimately led to trans fat being added to U.S. food labels in 2003 [19] and partially hydrogenated oils being labeled as not generally recognized as safe (GRAS) by the FDA. [20]

Obesity: correlated to a higher likelihood of cardiovascular disease (CVD), [21] breast cancer, [22] pancreatic cancer, [23] psoriasis, [24] multiple sclerosis, [25] gallstones, [26] type 2 diabetes, [27] and eye disease. [28]

Postmenopausal Hormone Therapy: correlated to a lower likelihood of cardiovascular disease (CVD). [29] Combination hormones (progesteron and estrogen) were associated with higher risk of breast cancer. [30] [31]

Oral Contraceptives: correlated to a lower likelihood of ovarian cancer. [32] No statistically significant effects of oral contraceptives were observed in regard to risk of breast cancer. [33] Present or past use did not correlate significantly with CVD. [34]

Exercise: correlated to higher likelihood of breast cancer survival. [35] Physical activity was correlated to a decreased likelihood of cardiovascular disease (CVD) [36] and type 2 diabetes. [37]

Many relationships and factors were examined over the course of the study, examples including diet, coffee consumption, and sleep. [38] Many publications diverse findings were produced as a result.

History

Oral Contraceptives publicly used in the United States in the 1970s Patient Package Insert for Oral Contraceptives (FDA 079) (8249451687).jpg
Oral Contraceptives publicly used in the United States in the 1970s

Beginning in the 1960s, oral contraceptives were used by the public in the U.S. and U.K. [5] As soon as 1966, however, there were reports of women falling ill with cardiovascular disease in association with these contraceptives. [5] Doctors Frank Speizer and Martin Vessey hoped to better understand the effects of long-term use of oral contraceptives on the health of women. [5] After receiving funding from the National Cancer Institute in 1974, the study was directed towards the wives of doctors. When it was discovered that such responses were not ideal due to lack of medical knowledge of the participants, the study shifted its focus to nurses. [5] The studies did not remain focused on oral contraceptives, but expanded to investigate factors such as smoking, diet, and exercise. These conditions demonstrated relationships with states of health, such as risk of developing chronic disease. [5] Because the women continued submitting their responses as time passed, the Nurses' Health Study was the first cohort study of such magnitude to follow a population over time. [5] The study has continued into 2018, and as of 2016 were funded almost entirely (90%) by the federal government. [5]

Impact

Data received from the study has expanded the understanding of women's health. Public messages from the United States Surgeon General, World Health Organization, and World Cancer Research Fund have resulted from the findings of the Nurses' Health Study. [40] Policies such as the 2008 Physical Activity Guidelines for Americans and the Dietary Guidelines of the Food and Drug Administration regarding trans-fat related to the findings of these studies. [40] Studies to date have led to the publication of hundreds of peer-reviewed papers. [41] Influential figures in the Nurses' Health Study have published advice for women based on their findings. For example, the book Healthy Women and Healthy Lives was written by Hankson, Colditz, Manson, and Speizer to reflect results of the study. This work makes explicit suggestions for a healthy lifestyle based on the study. [42]

Public reaction

This study was referenced in popular news by many sources. The term "Nurses' Health Study" has been stated in over three hundred articles of the New York Times and The Washington Post alone. These articles discussed the findings of the study, such as one titled Women, Alcohol and the Search for Certainty. [43] Published as early as 1988, this Washington Post article discussed the effect of the Nurses' Health Study on the relationship between women and alcohol, citing the former as a factor which affects a woman's risk for CVD and strokes. [43] News outlets have also described the more general implications of the study, such as a piece titled It's Never Too Late to Be Healthy, Studies Show. [44] The 2004 article discusses the research of the study and resulting understanding of general health in older populations. [44] The impact of the study itself was also in the public eye. In the New York Times article In Nurses' Lives, a Treasure Trove of Health Data, nurses themselves were cited as changing daily habits and considering their choices as a result of their participation. [45] In this way, the findings and magnitude of the Nurses Health Study reached the public throughout its history.

Limitations and controversy

The Nurses' Health Study 1 contained populations representing nurses of the time, but did not reflect great diversity. The participants had a slightly higher income than the average of the time and a majority were white (97%). [5] In 2012, however, minority participants were increasingly sought after. [40] Leaders of the experiment made this a priority by sending extra information on the study to possible subjects living in areas of high diversity. [5] In 2015 males were accepted into the study. [40] This was caused by an increase in the number of males in the nursing profession. [40]

The Nurses' Health Study faced controversy based on its recommendations. The study published in 1985 that taking estrogen as a part of Hormone Replacement Therapy would lead to large decreases in risk of heart disease (a third of the risk of those who did not take supplements). [46] However, the Framingham Heart Study found the opposite result. [47] This controversy caused a 10-year follow up by the Nurses' Health Study which again concluded that risks of CVD were lower in samples currently taking hormones. [47] However, further studies such as the Heart and Estrogen-progestin Replacement Study found that estrogen tablets actually increase risk for heart disease. This was a double-blind trial following an experimental group of women who were given replacement therapy pills and a control group following the same procedure with placebos. [48] Findings from the study displayed a direct relationship between therapy and risk for heart disease, as opposed to the previously stated benefits. [49] This finding largely opposed the published Nurses' Health Study conclusion.

See also

Related Research Articles

<span class="mw-page-title-main">Fat</span> Esters of fatty acid or triglycerides

In nutrition, biology, and chemistry, fat usually means any ester of fatty acids, or a mixture of such compounds, most commonly those that occur in living beings or in food.

<span class="mw-page-title-main">Progestogen (medication)</span> Medication producing effects similar to progesterone

A progestogen, also referred to as a progestagen, gestagen, or gestogen, is a type of medication which produces effects similar to those of the natural female sex hormone progesterone in the body. A progestin is a synthetic progestogen. Progestogens are used most commonly in hormonal birth control and menopausal hormone therapy. They can also be used in the treatment of gynecological conditions, to support fertility and pregnancy, to lower sex hormone levels for various purposes, and for other indications. Progestogens are used alone or in combination with estrogens. They are available in a wide variety of formulations and for use by many different routes of administration. Examples of progestogens include natural or bioidentical progesterone as well as progestins such as medroxyprogesterone acetate and norethisterone.

Oophorectomy, historically also called ovariotomy is the surgical removal of an ovary or ovaries. The surgery is also called ovariectomy, but this term is mostly used in reference to animals, e.g. the surgical removal of ovaries from laboratory animals. Removal of the ovaries of females is the biological equivalent of castration of males; the term castration is only occasionally used in the medical literature to refer to oophorectomy of women. In veterinary medicine, the removal of ovaries and uterus is called ovariohysterectomy (spaying) and is a form of sterilization.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

<span class="mw-page-title-main">Multivitamin</span> Dietary supplement containing vitamins

A multivitamin is a preparation intended to serve as a dietary supplement with vitamins, dietary minerals, and other nutritional elements. Such preparations are available in the form of tablets, capsules, pastilles, powders, liquids, or injectable formulations. Other than injectable formulations, which are only available and administered under medical supervision, multivitamins are recognized by the Codex Alimentarius Commission as a category of food.

The glycemic load (GL) of food is a number that estimates how much the food will raise a person's blood glucose level after it is eaten. One unit of glycemic load approximates the effect of eating one gram of glucose. Glycemic load accounts for how much carbohydrate is in the food and how much each gram of carbohydrate in the food raises blood glucose levels. Glycemic load is based on the glycemic index (GI), and is calculated by multiplying the weight of available carbohydrate in the food (in grams) by the food's glycemic index, and then dividing by 100.

<span class="mw-page-title-main">Women's Health Initiative</span> Long-term U.S. health study

The Women's Health Initiative (WHI) was a series of clinical studies initiated by the U.S. National Institutes of Health (NIH) in 1991, to address major health issues causing morbidity and mortality in postmenopausal women. It consisted of three clinical trials (CT) and an observational study (OS). In particular, randomized controlled trials were designed and funded that addressed cardiovascular disease, cancer, and osteoporosis.

A nested case–control (NCC) study is a variation of a case–control study in which cases and controls are drawn from the population in a fully enumerated cohort.

<span class="mw-page-title-main">Gallbladder disease</span> Medical condition

Gallbladder diseases are diseases involving the gallbladder and is closely linked to biliary disease, with the most common cause being gallstones (cholelithiasis).

Hormone replacement therapy (HRT), also known as menopausal hormone therapy or postmenopausal hormone therapy, is a form of hormone therapy used to treat symptoms associated with female menopause. Effects of menopause can include symptoms such as hot flashes, accelerated skin aging, vaginal dryness, decreased muscle mass, and complications such as osteoporosis, sexual dysfunction, and vaginal atrophy. They are mostly caused by low levels of female sex hormones that occur during menopause.

Large-cell lung carcinoma (LCLC), or large-cell carcinoma (LCC) in short, is a heterogeneous group of undifferentiated malignant neoplasms that lack the cytologic and architectural features of small cell carcinoma and glandular or squamous differentiation. LCC is categorized as a type of NSCLC which originates from epithelial cells of the lung. LCLC is histologically characterized by the presence of large, undifferentiated cells that lack distinctive features of either squamous cell carcinoma or adenocarcinoma. Typically seen in LCLC tumor cells are abundant pale staining cytoplasm and prominent nucleoli.

<span class="mw-page-title-main">Light in school buildings</span>

Light in school buildings traditionally is from a combination of daylight and electric light to illuminate learning spaces, hallways, cafeterias, offices and other interior areas. Light fixtures currently in use usually provide students and teachers with satisfactory visual performance, i.e., the ability to read a book, have lunch, or play basketball in a gymnasium. However, classroom lighting may also affect students' circadian systems, which may in turn affect test scores, attendance and behavior.

<span class="mw-page-title-main">Frank Hu</span> Nutrition researcher

Frank B. Hu is a Chinese American nutrition and diabetes researcher. He is Chair of the Department of Nutrition and the Fredrick J. Stare Professor of Nutrition and Epidemiology at the Harvard T.H. Chan School of Public Health, and Professor of Medicine at the Harvard Medical School.

<span class="mw-page-title-main">Mammoplasia</span> Normal or spontaneous enlargement of breasts

Mammoplasia is the normal or spontaneous enlargement of human breasts. Mammoplasia occurs normally during puberty and pregnancy in women, as well as during certain periods of the menstrual cycle. When it occurs in males, it is called gynecomastia and is considered to be pathological. When it occurs in females and is extremely excessive, it is called macromastia and is similarly considered to be pathological. Mammoplasia may be due to breast engorgement, which is temporary enlargement of the breasts caused by the production and storage of breast milk in association with lactation and/or galactorrhea. Mastodynia frequently co-occurs with mammoplasia.

<span class="mw-page-title-main">Estrogen (medication)</span> Type of medication

An estrogen (E) is a type of medication which is used most commonly in hormonal birth control and menopausal hormone therapy, and as part of feminizing hormone therapy for transgender women. They can also be used in the treatment of hormone-sensitive cancers like breast cancer and prostate cancer and for various other indications. Estrogens are used alone or in combination with progestogens. They are available in a wide variety of formulations and for use by many different routes of administration. Examples of estrogens include bioidentical estradiol, natural conjugated estrogens, synthetic steroidal estrogens like ethinylestradiol, and synthetic nonsteroidal estrogens like diethylstilbestrol. Estrogens are one of three types of sex hormone agonists, the others being androgens/anabolic steroids like testosterone and progestogens like progesterone.

Cardiovascular disease in women is an integral area of research in the ongoing studies of women's health. Cardiovascular disease (CVD) is an umbrella term for a wide range of diseases affecting the heart and blood vessels, including but not limited to, coronary artery disease, stroke, cardiomyopathy, myocardial infarctions, and aortic aneurysms.

Frank Erwin Speizer is an American physician and epidemiologist, currently Professor of Environmental Health and Environmental Science at Harvard T.H. Chan School of Public Health, and Edward H. Kass Distinguished Professor of Medicine at Brigham and Women's Hospital, Harvard Medical School. He is best known for his work on two major epidemiological cohort studies: the Nurses' Health Study, which explored women's illnesses and health risk factors, and the Harvard Six Cities study, which definitively linked air pollution to higher death rates in urban areas.

Francine Laden is an American epidemiologist who is Professor of Environmental Epidemiology at the Harvard T.H. Chan School of Public Health. Her research has investigated the environmental epidemiology of chronic disease. She serves as co-director of the Harvard University and Boston University center for research on environmental and social stressors in housing across the life course. Laden has also served on the United States Environmental Protection Agency advisory board.

Susan Hankinson is an American cancer researcher who is the Distinguished Professor of Epidemiology at the University of Massachusetts Amherst. Her research considers cancer epidemiology and the etiology of breast cancer. Her work has demonstrated the relationship between hormones and breast cancer risk. In 2023, she was awarded the American Association for Cancer Research Award for Research Excellence in Cancer Epidemiology and Prevention.

A. Heather Eliassen is an American public health researcher who is a professor of epidemiology at the Harvard T.H. Chan School of Public Health. Her research considers the epidemiology of breast cancer and the identification of modifiable risk factors to reduce breast cancer risk.

References

  1. 1 2 "Nurses' Health Studies". The Nurses' Health Study. 2016-08-16. Retrieved 2017-07-17.
  2. 1 2 Dave. "News - Nurses' Health Study". www.nhs3.org. Retrieved 2017-07-17.
  3. ↑ http://www.channing.harvard.edu/nhs/?page_id=73 Nurses' Health Study official site - participating organizations
  4. ↑ Feldscher, Karen. "Nurses' Health Study 3 ramps up its recruiting efforts". Harvard T.H. Chan School of Public Health. Retrieved February 2, 2020.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Bao, Ying; Bertoia, Monica; Lenart, Elizabeth; Stampfer, Meir; Willett, Walter; Speizer, Frank; Chavarro, Jorge (September 2016). "Origin, Methods, and Evolution of the Three Nurses' Health Studies". American Journal of Public Health. 106 (9): 1573–1581. doi:10.2105/AJPH.2016.303338. PMC   4981810 . PMID   27459450.
  6. 1 2 3 4 5 "History | Nurses' Health Study". www.nurseshealthstudy.org. Retrieved 2017-07-17.
  7. ↑ "Principal investigators | Nurses' Health Study".
  8. 1 2 3 "History | Nurses' Health Study". www.nurseshealthstudy.org. Retrieved 2018-11-16.
  9. ↑ Chavarro, Jorge; Rich-Edwards, Janet; Gaskins, Audrey; Farland, Leslie; Terry, Kathryn; Zhang, Cuilin; Missmer, Stacy (September 2016). "Contributions of the Nurses' Health Studies to Reproductive Health Research". American Journal of Public Health. 106 (9): 1669–1676. doi:10.2105/AJPH.2016.303350. PMC   4981818 . PMID   27459445.
  10. ↑ Willett, W. C.; Green, A.; Stampfer, M. J.; Speizer, F. E.; Colditz, G. A.; Rosner, B.; Monson, R. R.; Stason, W.; Hennekens, C. H. (1987-11-19). "Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes". The New England Journal of Medicine. 317 (21): 1303–1309. doi:10.1056/NEJM198711193172102. ISSN   0028-4793. PMID   3683458.
  11. ↑ Wei, Esther K.; Giovannucci, Edward; Wu, Kana; Rosner, Bernard; Fuchs, Charles S.; Willett, Walter C.; Colditz, Graham A. (2004-01-20). "Comparison of risk factors for colon and rectal cancer". International Journal of Cancer. 108 (3): 433–442. doi:10.1002/ijc.11540. ISSN   0020-7136. PMC   2903217 . PMID   14648711.
  12. ↑ Fuchs, C. S.; Colditz, G. A.; Stampfer, M. J.; Giovannucci, E. L.; Hunter, D. J.; Rimm, E. B.; Willett, W. C.; Speizer, F. E. (1996-10-28). "A prospective study of cigarette smoking and the risk of pancreatic cancer". Archives of Internal Medicine. 156 (19): 2255–2260. doi:10.1001/archinte.1996.00440180119015. ISSN   0003-9926. PMID   8885826.
  13. ↑ Setty, Arathi R.; Curhan, Gary; Choi, Hyon K. (2007-11-01). "Smoking and the Risk of Psoriasis in Women: Nurses' Health Study II". The American Journal of Medicine. 120 (11): 953–959. doi:10.1016/j.amjmed.2007.06.020. ISSN   0002-9343. PMC   2696351 . PMID   17976422.
  14. ↑ Hernan, M. A. (2001-07-01). "Cigarette Smoking and Incidence of Multiple Sclerosis". American Journal of Epidemiology. 154 (1): 69–74. doi: 10.1093/aje/154.1.69 . ISSN   0002-9262. PMID   11427406.
  15. ↑ Rimm, E. B.; Manson, J. E.; Stampfer, M. J.; Colditz, G. A.; Willett, W. C.; Rosner, B.; Hennekens, C. H.; Speizer, F. E. (1993). "Cigarette smoking and the risk of diabetes in women". American Journal of Public Health. 83 (2): 211–214. doi:10.2105/AJPH.83.2.211. ISSN   0090-0036. PMC   1694562 . PMID   8427325.
  16. ↑ Hankinson, S. E.; Willett, W. C.; Colditz, G. A.; Seddon, J. M.; Rosner, B.; Speizer, F. E.; Stampfer, M. J. (1992-08-26). "A prospective study of cigarette smoking and risk of cataract surgery in women". JAMA. 268 (8): 994–998. doi:10.1001/jama.1992.03490080068026. ISSN   0098-7484. PMID   1501325.
  17. ↑ Willett, W. C.; Stampfer, M. J.; Manson, J. E.; Colditz, G. A.; Speizer, F. E.; Rosner, B. A.; Sampson, L. A.; Hennekens (1993-03-06). "Intake of trans fatty acids and risk of coronary heart disease among women". Lancet. 341 (8845): 581–585. doi:10.1016/0140-6736(93)90350-p. PMID   8094827. S2CID   2616254.
  18. ↑ "NURSES' HEALTH STUDY NEWSLETTER" (PDF). Retrieved 2020-11-15.,
  19. ↑ "Small Entity Compliance Guide on Labeling Trans". 20 August 2003. Retrieved 2020-11-15.
  20. ↑ "Final Determination Regarding Partially Hydrogenated Oils (Removing Trans Fat)". FDA. 20 February 2020. Retrieved 2020-11-15.
  21. ↑ Eckel, N; Li, Y; Kuxhaus, O; Stefan, N; Hu, FB; Schulze, MB (2018). "Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses' Health Study): 30 year follow-up from a prospective cohort study". Lancet Diabetes Endocrinol. 6 (9): 714–724. doi:10.1016/S2213-8587(18)30137-2. PMID   29859908. S2CID   44135432.
  22. ↑ Hirko, KA; Chai, B; Spiegelman, D; Campos, H; Farvid, MS; Hankinson, SE; Willett, WC; Eliassen, AH (2018). "Erythrocyte membrane fatty acids and breast cancer risk: a prospective analysis in the nurses' health study II". International Journal of Cancer. 142 (6): 1116–1129. doi:10.1002/ijc.31133. PMC   5773390 . PMID   29071721.
  23. ↑ Michaud, Dominique S. (2001-08-22). "Physical Activity, Obesity, Height, and the Risk of Pancreatic Cancer". JAMA. 286 (8): 921–9. doi: 10.1001/jama.286.8.921 . ISSN   0098-7484. PMID   11509056.
  24. ↑ Setty, Arathi R.; Curhan, Gary; Choi, Hyon K. (2007). "Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses' Health Study II". Archives of Internal Medicine. 167 (15): 1670–1675. doi: 10.1001/archinte.167.15.1670 . ISSN   0003-9926. PMID   17698691.
  25. ↑ Munger, Kassandra L.; Chitnis, Tanuja; Ascherio, Alberto (2009-11-10). "Body size and risk of MS in two cohorts of US women". Neurology. 73 (19): 1543–1550. doi:10.1212/WNL.0b013e3181c0d6e0. ISSN   0028-3878. PMC   2777074 . PMID   19901245.
  26. ↑ Field, Alison E.; Coakley, Eugenie H.; Must, Aviva; Spadano, Jennifer L.; Laird, Nan; Dietz, William H.; Rimm, Eric; Colditz, Graham A. (2001-07-09). "Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period". Archives of Internal Medicine. 161 (13): 1581–6. doi: 10.1001/archinte.161.13.1581 . ISSN   0003-9926. PMID   11434789.
  27. ↑ Carey, Vincent; Walters, Ellen; Colditz, Graham; Solomon, Caren; Willet, Walter; Rosner, Bernard; Speizer, Frank E.; Manson, JoAnn (1997). "Body Fat Distribution and Risk of Non-Insulin-dependent Diabetes Mellitus in Women: The Nurses' Health Study". American Journal of Epidemiology. 145 (7): 614–9. doi: 10.1093/oxfordjournals.aje.a009158 . PMID   9098178.
  28. ↑ Weintraub, JM; Willett, WC; Rosner, B; Colditz, GA; Seddon, JM; Hankinson, SE (December 2002). "A prospective study of the relationship between body mass index and cataract extraction among US women and men". International Journal of Obesity. 26 (12): 1588–1595. doi: 10.1038/sj.ijo.0802158 . ISSN   0307-0565. PMID   12461675.
  29. ↑ Stampfer, M. J.; Willett, W. C.; Colditz, G. A.; Rosner, B.; Speizer, F. E.; Hennekens, C. H. (1985-10-24). "A prospective study of postmenopausal estrogen therapy and coronary heart disease". The New England Journal of Medicine. 313 (17): 1044–1049. doi:10.1056/NEJM198510243131703. ISSN   0028-4793. PMID   4047106.
  30. ↑ Colditz, G. A.; Hankinson, S. E.; Hunter, D. J.; Willett, W. C.; Manson, J. E.; Stampfer, M. J.; Hennekens, C.; Rosner, B.; Speizer, F. E. (1995-06-15). "The use of estrogens and progestins and the risk of breast cancer in postmenopausal women". The New England Journal of Medicine. 332 (24): 1589–1593. doi: 10.1056/NEJM199506153322401 . ISSN   0028-4793. PMID   7753136.
  31. ↑ "Selected publications | Nurses' Health Study". www.nurseshealthstudy.org. Retrieved 2018-11-16.
  32. ↑ Collaborative Group on Epidemiological Studies of Ovarian Cancer; Beral, V.; Doll, R.; Hermon, C.; Peto, R.; Reeves, G. (2008-01-26). "Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls". Lancet. 371 (9609): 303–314. doi:10.1016/S0140-6736(08)60167-1. hdl: 1885/33446 . ISSN   1474-547X. PMID   18294997. S2CID   138957030.
  33. ↑ Lipnick, R. J.; Buring, J. E.; Hennekens, C. H.; Rosner, B.; Willett, W.; Bain, C.; Stampfer, M. J.; Colditz, G. A.; Peto, R. (1986-01-03). "Oral contraceptives and breast cancer. A prospective cohort study". JAMA. 255 (1): 58–61. doi:10.1001/jama.1986.03370010064026. ISSN   0098-7484. PMID   3940306.
  34. ↑ Stampfer, Meir J.; Willett, Walter C.; Colditz, Graham A.; Speizer, Frank E.; Hennekens, Charles H. (July 1990). "Past use of oral contraceptives and cardiovascular disease: A meta-analysis in the context of the Nurses' Health Study". American Journal of Obstetrics and Gynecology. 163 (1): 285–291. doi:10.1016/0002-9378(90)90569-S. ISSN   0002-9378. PMID   2142573.
  35. ↑ Irwin, Melinda L.; Smith, Ashley Wilder; McTiernan, Anne; Ballard-Barbash, Rachel; Cronin, Kathy; Gilliland, Frank D.; Baumgartner, Richard N.; Baumgartner, Kathy B.; Bernstein, Leslie (2008-08-20). "Influence of Pre- and Postdiagnosis Physical Activity on Mortality in Breast Cancer Survivors: The Health, Eating, Activity, and Lifestyle Study". Journal of Clinical Oncology. 26 (24): 3958–3964. doi:10.1200/JCO.2007.15.9822. ISSN   0732-183X. PMC   2654316 . PMID   18711185.
  36. ↑ Manson, JoAnn E.; Hu, Frank B.; Rich-Edwards, Janet W.; Colditz, Graham A.; Stampfer, Meir J.; Willett, Walter C.; Speizer, Frank E.; Hennekens, Charles H. (1999-08-26). "A Prospective Study of Walking as Compared with Vigorous Exercise in the Prevention of Coronary Heart Disease in Women" (PDF). New England Journal of Medicine. 341 (9): 650–658. doi:10.1056/nejm199908263410904. ISSN   0028-4793. PMID   10460816.
  37. ↑ Manson, J. E.; Rimm, E. B.; Stampfer, M. J.; Colditz, G. A.; Willett, W. C.; Krolewski, A. S.; Rosner, B.; Hennekens, C. H.; Speizer, F. E. (1991-09-28). "Physical activity and incidence of non-insulin-dependent diabetes mellitus in women". Lancet. 338 (8770): 774–778. doi:10.1016/0140-6736(91)90664-B. ISSN   0140-6736. PMID   1681160. S2CID   33132152.
  38. ↑ COLDITZ, GRAHAM A.; MANSON, JOANN E.; HANKINSON, SUSAN E. (1997). "The Nurses' Health Study: 20-Year Contribution to the Understanding of Health Among Women". Journal of Women's Health. 6 (1): 49–62. doi:10.1089/jwh.1997.6.49. ISSN   1059-7115. PMID   9065374.
  39. ↑ "File:Patient Package Insert for Oral Contraceptives (FDA 079) (8249451687).jpg", Wikipedia, retrieved 2018-11-16
  40. 1 2 3 4 5 Colditz, Graham; Philpott, Sydney; Hankinson, Susan E. (September 2016). "The Impact of the Nurses' Health Study on Population Health: Prevention, Translation, and Control". American Journal of Public Health. 106(9) (September 216): 1540–1545. doi:10.2105/AJPH.2016.303343. PMC   4981811 . PMID   27459441.
  41. ↑ "Google Sites: Sign-in". accounts.google.com.
  42. ↑ Hankinson, Susan; Colditz, Graham; Manson, JoAnn; Speizer, Frank (2001). Healthy Women, Healthy Lives . New York, NY: Simon & Schuster. ISBN   978-0-684-85519-6.
  43. 1 2 Rovner, Sandy (9 August 1988). "Women, Alcohol and the Search for Certainty". The Washington Post.
  44. 1 2 Stein, Rob (22 September 2004). "It's Never Too Late to Be Healthy, Studies Show". The Washington Post.
  45. ↑ Yoon, Carol Kaesuk (15 September 1998). "In Nurses' Lives, a Treasure Trove of Health Data". The New York Times. Retrieved 2018-11-16.
  46. ↑ Taubes, Gary (17 September 2007). "Do We Really Know What Makes Us Healthy?". The New York Times.
  47. 1 2 Stampfer, Meir J.; Colditz, Graham A.; Willett, Walter C.; Manson, JoAnn E.; Rosner, Bernard; Speizer, Frank E.; Hennekens, Charles H. (1991-09-12). "Postmenopausal Estrogen Therapy and Cardiovascular Disease". New England Journal of Medicine. 325 (11): 756–762. doi: 10.1056/nejm199109123251102 . ISSN   0028-4793. PMID   1870648.
  48. ↑ Grady, Deborah; Applegate, William; Bush, Trudy; Furberg, Curt; Riggs, Betty; Hulley, Stephen (August 1998). "Heart and Estrogen/progestin Replacement Study (HERS): Design, Methods, and Baseline Characteristics". Controlled Clinical Trials. 19 (4): 314–335. doi:10.1016/S0197-2456(98)00010-5. PMID   9683309.
  49. ↑ Blakely, John A. (2000-10-23). "The Heart and Estrogen/Progestin Replacement Study Revisited". Archives of Internal Medicine. 160 (19): 2897–900. doi: 10.1001/archinte.160.19.2897 . ISSN   0003-9926. PMID   11041895.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.