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Nurses' Health Study

March 04, 2023

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]

Cohorts

Cohorts[4]
Study Year PI Enrollees
Nurses' Health Study 1976 Frank Speizer 121,700
Nurses' Health Study II 1989 Walter Willett 116,430
Nurses' Health Study 3 2010 Jorge Chavarro target: 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[39]

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.[43] These articles discussed the findings of the study, such as one titled Women, Alcohol and the Search for Certainty.[44] 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.[44] 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.[45] The 2004 article discusses the research of the study and resulting understanding of general health in older populations.[45] 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.[46] 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).[47] However, the Framingham Heart Study found the opposite result.[48] 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.[48] 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.[49] Findings from the study displayed a direct relationship between therapy and risk for heart disease, as opposed to the previously stated benefits.[50] This finding largely opposed the published Nurses' Health Study conclusion.

See also

References

  1. ^ a b "Nurses' Health Studies". The Nurses' Health Study. 2016-08-16. Retrieved 2017-07-17.
  2. ^ a b 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. ^ a b c d e f g h i j k l m n o p q r s t 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. ^ a b c d e "History | Nurses' Health Study". www.nurseshealthstudy.org. Retrieved 2017-07-17.
  7. ^ "Principal investigators | Nurses' Health Study".
  8. ^ a b c "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. ^ a b c d e 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. ^ List of NHS publications indexed by year
  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. ^ "Factiva".
  44. ^ a b Rovner, Sandy (9 August 1988). "Women, Alcohol and the Search for Certainty". The Washington Post.
  45. ^ a b Stein, Rob (22 September 2004). "It's Never Too Late to Be Healthy, Studies Show". The Washington Post.
  46. ^ Yoon, Carol Kaesuk. "In Nurses' Lives, a Treasure Trove of Health Data". Retrieved 2018-11-16.
  47. ^ Taubes, Gary (17 September 2007). "Do We Really Know What Makes Us Healthy?". The New York Times.
  48. ^ a b 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.
  49. ^ 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.
  50. ^ 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.

External links

  • Channing.harvard.edu - 'The Nurses' Health Study', Channing Laboratory, Harvard University
  • Video series on history of Nurses' Health Studies
  • PBS Frontline interview with Walter Willett (April 8, 2004)

March 04, 2023
nurses, health, study, this, article, needs, more, medical, references, verification, relies, heavily, primary, sources, please, review, contents, article, appropriate, references, unsourced, poorly, sourced, material, challenged, removed, find, sources, news,. This article needs more medical references for verification or relies too heavily on primary sources Please review the contents of the article and add the appropriate references if you can Unsourced or poorly sourced material may be challenged and removed Find sources Nurses Health Study news newspapers books scholar JSTOR November 2021 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 1 Cohorts 2 Findings 3 History 4 Impact 5 Public reaction 6 Limitations and controversy 7 See also 8 References 9 External linksCohorts EditCohorts 4 Study Year PI EnrolleesNurses Health Study 1976 Frank Speizer 121 700Nurses Health Study II 1989 Walter Willett 116 430Nurses Health Study 3 2010 Jorge Chavarro target 100 000The 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 EditThe 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 Edit Oral Contraceptives publicly used in the United States in the 1970s 39 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 EditData 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 EditThis 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 43 These articles discussed the findings of the study such as one titled Women Alcohol and the Search for Certainty 44 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 44 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 45 The 2004 article discusses the research of the study and resulting understanding of general health in older populations 45 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 46 In this way the findings and magnitude of the Nurses Health Study reached the public throughout its history Limitations and controversy EditThe 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 47 However the Framingham Heart Study found the opposite result 48 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 48 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 49 Findings from the study displayed a direct relationship between therapy and risk for heart disease as opposed to the previously stated benefits 50 This finding largely opposed the published Nurses Health Study conclusion See also EditBritish Doctors Study Framingham Heart StudyReferences Edit a b Nurses Health Studies The Nurses Health Study 2016 08 16 Retrieved 2017 07 17 a b Dave News Nurses Health Study www nhs3 org Retrieved 2017 07 17 http www channing harvard edu nhs page id 73 Nurses Health Study official site participating organizations Feldscher Karen Nurses Health Study 3 ramps up its recruiting efforts Harvard T H Chan School of Public Health Retrieved February 2 2020 a b c d e f g h i j k l m n o p q r s t 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 a b c d e History Nurses Health Study www nurseshealthstudy org Retrieved 2017 07 17 Principal investigators Nurses Health Study a b c History Nurses Health Study www nurseshealthstudy org Retrieved 2018 11 16 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 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 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 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 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 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 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 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 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 NURSES HEALTH STUDY NEWSLETTER PDF Retrieved 2020 11 15 Small Entity Compliance Guide on Labeling Trans 20 August 2003 Retrieved 2020 11 15 Final Determination Regarding Partially Hydrogenated Oils Removing Trans Fat FDA 20 February 2020 Retrieved 2020 11 15 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 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 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 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 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 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 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 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 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 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 Selected publications Nurses Health Study www nurseshealthstudy org Retrieved 2018 11 16 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 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 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 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 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 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 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 File Patient Package Insert for Oral Contraceptives FDA 079 8249451687 jpg Wikipedia retrieved 2018 11 16 a b c d e 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 List of NHS publications indexed by year Hankinson Susan Colditz Graham Manson JoAnn Speizer Frank 2001 Healthy Women Healthy Lives New York NY Simon amp Schuster ISBN 978 0 684 85519 6 Factiva a b Rovner Sandy 9 August 1988 Women Alcohol and the Search for Certainty The Washington Post a b Stein Rob 22 September 2004 It s Never Too Late to Be Healthy Studies Show The Washington Post Yoon Carol Kaesuk In Nurses Lives a Treasure Trove of Health Data Retrieved 2018 11 16 Taubes Gary 17 September 2007 Do We Really Know What Makes Us Healthy The New York Times a b 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 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 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 External links EditChanning harvard edu The Nurses Health Study Channing Laboratory Harvard University Video series on history of Nurses Health Studies PBS Frontline interview with Walter Willett April 8 2004 Retrieved from https en wikipedia org w index php title Nurses 27 Health Study amp oldid 1126998211, wikipedia, wiki, book, books, library,

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