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NURSES' HEALTH STUDY as initiators (cigarette smoking and colon can- cer risk),42 promoters (red meat for colon can- cer), or proliferators (estrogens for breast can- cer). Repeated measures and long-term follow-up permit a detailed understandin~ of these relations. The detailed history of use of vitamin supplements, at different doses and over varying durations, adds a richness to the data that cannot be obtained through a ran- domized study in which the dose and duration are predetermined (and are perhaps more or less than ideal). This unique feature will allow the identification of the dietary and other lifestyle factors that are most beneficial to women in terms of morbidity, mortality, and quality of life as the study continues through the coming years. Through the Nurses' Health Study, many im- portant advances have been made in under- standing the etiology and prevention of major illnesses among women. Before the Women's Health Initiative began, the Nurses" Health Study study was the largest and most compre- hensive study of health among women. It re- mains the most detailed study of diet and ma- jor illnesses, providing details on many components of lifestyle updated over the years. This unique study will continue to shed light on the causes and prevention of disease and the fea- tures of healthy aging over the coming years. Needless to say, this all reflects the enormous contribution made by over 120,000 registered nurses who entered the study 20 years ago. ACKNOWLEDGMENTS The continuing commitment of the study participants is g(atefully acknowledged. The investigators on the Nurses' Health Study have made major contributions over the years. Gur- rent members of the study team include Cath- erine Berkey, Celia Byrne, Carlos Camargo, Vincent Carey, Gary Chase, Graham Colditz, Karen Corsano, Gary Curhan, Barbara Egan, Diane Feskanich, Lindsay Frazier, Charles Fuchs, Edward Giovannucci, Francine Grodstein, Susan Hankinson, Charles Hennekens, David Hunter, JoAnn Manson, Stefanie Parker, Cathy Rexrode, Janet Rich-Edwards, Bernard Rosner, Caren Solomon, Meir Stampfer, Harry Taplin, 59 Waiter Willett, and Frank E. Speizer (principal investigator). REFERENCES 1. Barton J, Bain C, Hennekens CH, et al. Characteristics of respondents and non-respondents to a mailed questionnaire. Am J Public Health 1980;70:823. 2. Stampfer M-J, Willett WC, FE, et al. Test of the National Death Index. Am J Epidemiol 1984;119:837. 3. Rimm EB, Stampfer MJ, Colditz G, Giovannucci E, Willett WC. Effectiveness of various marling strate- gies among nonrespondents in a prospective cohort study. Am J Epidemiol 1990;131:1068. 4. Rose GA, Blackburn H. Cardiovascular survey meth- ods. WHO Monograph Series No. 58. Geneva: World Health Organization, 1982. 5. Walker AE, Robins M, Weinfeld FD. The National Survey of Stroke. Clinical findings. Stroke 1981;12(2 Part 2 Suppl 1):I13. 6. Doll R, Hill A. Lung cancer and other causes of death in relation to smoking. A second report on the mor- tality of British doctors. Br Med J 1956 (November 10):1071. 7. Colditz GA, Martin P, Stampfer MJ, et al. Validation of questionnaire information on risk factors and dis- ease outcomes in a prospective cohort study of women. Am J Epidemiol 1986;123:894. 8. Giovannucci E, Tosteson T, Speizer F, Vessey M, Colditz G. A long-term study of mortality in men who have undergone vasectomy. N Engl J Med 1992;326: 1392. 9. Willett WC, Sampson L, Stampfer MJ, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 1985; 122:51. 10. Hunter DJ, Sampson L, Stampfer M~, Colditz GA, Rosner B, Willett WC. Variability in portion sizes of commonly consumed foods among a population of women in the United States. Am J Epidemio11988;127: 1240. 11. Salvini S, Hunter DJ, Sampson L, et al. Food-based validation of a dietary questionnaire: The effects of week-to-week variation in food consumption. Int J Epidemiol 1989;18:858. 12. Wiliett WC, Stampfer MJ, Underwood BA, Speizer FE, .Rosner B, Hennekens CH. Validation of a dietary questionnaire with plasma carotenoid and alpha-to- copherol levels. Am J Clin Nutr 1983;38:631. 13. Willett WC. Nutritional epidemiology. New York: Oxford University Press, 1990. 14. Colditz GA, Willett WC, Stampfer MJ, et al. The in- fluence of age, relative weight, smoking, and alcohol intake on the reproducibility of a dietary question- naire. Int J Epidemiol 1987;16:392. 15. Ullrey DE. Selenium in the soil-plant-food chain. In: Spallhotz JE, et al., eds. Selenium in biology and med- icine. Westport, CT: AVI Publishing, 1981:176.

6O 16. Morris JS, Stampfer MJ, Willett WC. Dietary selenium in humans: Toenails as an indicator. Boil Trace Ele- ment Res 1983;5:529. 17. Hankinson S, Manson J, Speigelman D, Willett W, Longcope C, Speizer F. Reproduci.bility of plasma hormone levels in postmenopausal women over a 2-3 year period. Cancer Epidemiol Biol Prey 1995;4:649. 18. Hankinson SE, Willett WC, Manson JE, et al. Alcohol, height, and adiposity in relation to estrogen and pro- lactin levels in postmenopausal women. J Nat Cancer Inst 1995:1297. 19. Ware J, Snow K, Kosinski M, Gandek B. SF-36. Manual and interpretation guide. Boston: The Health Institute, New England Medical Center, 1993. 20. Karasek R, Theorell T. Health work: Stress, produc- tivity, and the reconstruction of working life. New York: Basic Books, 1990. 21. Berkman LF, Syme SL. Social networks, host resis- tance and mortality: A nine-year follow-up study of Alameda County residents. Am J Epidemio11979;109: 186. 22. Thalji L, Haggerty CC, Rubin R, Berckmans TR, .Pardee BL. National survey of junctional health sta- tus: Final report. Chicago: National Opinion Research Center, 1991. 23. Colditz GA. The Nurses' Health Study: Findings dur- ing 10 years of follow-up of a cohort of US women. Curt Probl Obstet Gynecol Fertil 1990;13:129. 24. Martinez M, Giovannucci E, Colditz G, et al. Calcium, vitamin D, and the occurrence of colorectal cancer among women. J Natl Cancer Inst 1996;88:1375. 25. Fuchs C, Colditz G, Stampfer M, et al. A prospective study of cigarette smoking and the risk of pancreatic cancer. Arch Intern Med 1996;156:2255. 26. Hankinson S, Colditz G, Hunter D, et al. A prospec- tive study of reproductive factors and risk of epithe- lial ovarian cancer. Cancer 1995;76:284. 27. Willett WC, Manson JE, Stampfer MJ, et al. Weight, weight change, and coronary heart disease in women: Risk within the "normal" weight range. JAMA 1995; 273:461. 28. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes in women. Ann Intern Med 1995;122:481. 29. Manson JE, Willett WC, Stampfer MJ, et al. Body weight and mortality among women. N Engl J Med 1995;333:677. 30. U.S. Department of Agriculture. Repo.rt of the dietary guidelines advisory committee on the dietary guide- lines for Americans, 1995. To the Secretary of Health and Human Services and the Secretary of Agriculture. Washington, DC: U.S. Department of Agriculture, 1995. 31. Colditz GA, Hankinson SE, Hunter DJ, et al. The use of estrogens and progestins and the risk of breast can- cer in postmenopausal women. N Engl J Med t995; 332:1589. 32. Grodstein F, Stampfer M, Manson J, et al. Post- menopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med 1996;335:453. COLDITZ ET AL. 33. Giovannucci E, Egan KM, Hunter DJ, et al. Aspirin and the risk of colorectal cancer in women. N Engi J Med 1995;333:609. 34. Willett W, Stampfer M, Manson J, et al. Coffee con- sumption and coronary heart disease in women: A ten-year follow-up. JAMA 1996;275:458. 35. Kawachi I, Willett W; Colditz G, Stampfer M, Speizer F. A prospective study of coffee drinking and suicide in women. Arch Intern Med 1996;156:521. 36. Colditz G, for the NHS Research Group. Oral contra- ceptive use and mortality during twelve years of fol- low-up: The Nurses' Health Study. Ann Intern Med 1994;120:821. 37. Kawachi I, Colditz GA, Stampfer MJ, et al. Smoking cessation in relation to total mortality rates in women: A prospective cohort study. Ann Intern Med 1993; 119:992. 38. Fuchs CS, Stampfer M-J, Colditz GA, et al. Alcohol consumption and mortality among women. N Engl J Med 1995;332:1245. 39. King M-C, Rowell S, Love SM. Inherited breast and ovarian cancer. What are the risks? What are the choices? JAMA 1993;269:1975. 40. Rosner B, Colditz G. Extended mathematical model of breast cancer inddence 'in the Nurses" Health Study. J Natl Cancer Inst 1996;88:359. 41. Roth A, Graham D, Schmittling G. National sample survey of registered nurses (1977). A report on the nurse population and factors affecting their supply. Hyattsville: Public Health Service, 1977. 42. Giovannucd E, Colditz GA, Stampfer MJ, et al. A prospective study of cigarette smoking and risk of col- orectal adenoma and colorectal cancer in U.S. women. J Natl Cancer Inst 1994;86:192. 43. London SJ, Colditz GA, Stampfer MJ, Willett WC, Rosner BA, Speizer FE. Prospective study of smoking and the risk of breast cancer. J Natl Cancer Inst 1989; 81:1625. 44. Willett WC, Green A, Stampfer MJ, et al. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med 1987;317: 1303. 45. Kawachi I, Colditz G, Stampfer M, et al. Smoking ces- sation and time course of decreased risk of coronary heart disease in women. Arch Intern Med 1993; 154:169. 46. Colditz GA, Bonita R, Stampfer MJ, et al. Cigarette smoking and risk of stroke in middle-aged women. N Engl J Med 1988;318:937. 47. Kawachi I, Colditz G, Stampfer M, et al. Smoking ces- sation and decreased risk of stroke in women. JAMA 1993;269:232. 48. Rimm EB, Manson JE, Stampfer MJ, et al. Cigarette smoking and the risk of diabetes in wombn. Am J Public Health 1993;83:211. 49. Hemenway D, Sondick S, Colditz G. Smoking, sui- cide, and nurses. Am J Public Health 1993;83:249. 50. Hankinson SE, Willett WC, Colditz GA, et al. A prospective study of smoking and risk of. cataract surgery in women. JAMA 1992;268:994. cO O~ 0

NURSES' HEALTH STUDY 51. Kawachi I, Troisi R, Rotnitzky A, Coakley E, Speizer F, Colditz G. A prospective study of smoking cessa- tion and weight change in women. J Smoking Rel Dis 1994;5(Suppl 1):91. 52. Romieu L Willett WC, Colditz GA, et al. A prospec- tive study of oral contraceptive use and the risk of breast cancer in women. J Natl Cancer Inst 1989;81: 1313. 53. Stampfer MJ, Willett WC, Colditz GA, Speizer ICE, Hennekens CH. A prospective study of past use of oral contraceptive agents and risk of cardiovascular diseases. N Engl J Med 1988;319:1313. 54. Chute CG, Willett WC, Colditz GA, Stampfer MJ, Rosner B, Speizer IrE. A prospective study of repro- ductive history and exogenous estrogens on the risk of colorectal cancer in women. Epidemiology 1991;2: 201. 55. Rimm E, Manson J, Stampfer M, et al. Oral contra- ceptive use and the risk of non-insulin-dependent di- abetes mellitus in a large prospective study of women. Diabetologia 1992;35:967. 56. Hernandez-Avfla M, Liang MH, Willett WC, et al. Exogenous sex hormones and the risk of rheumatoid arthritis. Arthritis Rheum 1990;33:947. 57. Stampfer MJ, Colditz GA, Willett WC, et al. Postmenopausal estrogen therapy and cardiovascular disease. N Engl J Med 1991;325:756. 58. Manson J, Rimm E, Colditz G, et al. A prospective study of postmenopausal estrogen therapy and sub- sequent incidence of noninsulin-dependent diabetes mellitus. Ann Epidemiol 1992;2:665. 59. Sanchez-Guerrero J, Liang M, Karlson E, Hunter D, Colditz G. Postmenopausal estrogen therapy and risk of developing systemic lupus erythematosus. Ann Intern Med 1995;122:430. 60. Grodstein F, Colditz G, Stampfer M. Postmenopausal hormone use and cholecystectomy in a large prospec- tive study. Obstet Gynecol 1994;83:5. 61. London SJ, Colditz GA, Stampfer MJ, Willett WC, Rosner B, Speizer FE. Prospective study of relative weight, height and the risk of breast cancer. JAMA 1989;262:2853. 62. Manson JE, Colditz GA, Stampfer MJ, et al. A prospec- tive study of obesity and risk of coronary heart dis- ease in women. N Engl J Med 1990;332:882. 63. Chute C, Willett W, Colditz G, et al. A prospective study of body mass, height, and smoking on the risk of colorectal cancer in women. Cancer Causes Control 1991;2:117. 64. Colditz Ga, Willett WC, Stampfer MJ, et al. Weight as a risk factor for clinical diabetes in women. Am J Epidemiol 1990;132:501. 65. Maclure KM,-Hayes KC, Colditz GA, Stampfer MJ, Speizer FE, Willett WC. Weight, diet and risk of symp- tomatic gallstones in middle-aged women. N Engl J Med 1989;321:563. 66. Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Hennekens CH, Speizer FE. Moderate alcohol con- sumption and the risk of breast cancer. N Engl J Med 1987;316:I174. 61 67. Stampfer MJ, Colditz GA, Willett WC, et al. A prospective study of moderate alcohol drinking and risk of diabetes in women. Am J Epidemiol 1988; 128:549. 68. Giovannucci E, Stampfer MJ, Colditz GA, et al. Folate, methionine and alcohol intake and risk of colorectal adenoma. J Natl Cancer Inst 1993;85:875. 69. Hernandez-Avila M, Colditz GA, Stampfer MJ, Rosner B, Speizer FE, Willett WC. Caffeine, moderate alcohol intake and risk of fractures of the hip and fore- arm among middle-aged women. Am J Clin Nutr 1991;54:157. 70. Hunter DJ, Manson JE, Colditz GA, et al. A prospec- tive study of intake of vitamins C, E and A and risk of breast cancer. N Engl J Med 1993;329:234. 71. Willett WC, Hunter DJ, Stampfer MJ, et al. Dietary fat and fiber in relation to risk of breast cancer. An eight- year follow-up. JAMA 1992;268:2037. 72. Hunter DJ, Morris JS, Stampfer MJ, Colditz GA, Speizer FE, Willett WC. A prospective study of sele- nium status and breast cancer risk. JAMA 1990; 264:1128. 73. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC. A prospective study of vitamin E consumption and risk of coronary disease in women. N Engl J Med 1993;328:1444. 74. Willett WC, Stampfer MJ, Manson JE, et al. Trans-fatty acid intake in relation to risk of coronary heart dis- ease among women. Lancet 1993;341:581. 75. Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Speizer irE. Relation of meat, fat and fiber intake to colon cancer risk in a prospective study among women. N Engl J Med 1990;323;1664. 76. Kampman E, Giovannucci E, van't Veer P, et al. Calcium, vitamin D, dairy foods and the occurrence of colorectal adenomas among men and women in two prospective studies. Am J Epidemiol 1994;139:16. 77. Feskanich D, Colditz G, Stampfer M, Willett W. Dietary calcium and bone fractures in middle-aged women. [Abstract] Am J Epidemiol 1994;139:$35. 78. Feskanich D, Willett W, Stampfer M, Colditz G. Protein consumption and bone fractures in women. Am J Epidemiol 1996:143:472. 79. Colditz G, Manson J, Stampfer M, Rosner B, Willett W, Speizer F. Diet and risk of clinical diabetes in women. Am J Clin Nutr 1992;55:1018. 80. Hankinson SE, Stampfer MJ, Seddon JM, et al. Nutrient intake and cataract extraction in women: A prospective study. Br Med J 1992:305:335. 81. Troisi R, Willett W, Weiss S, Trichopoulos D, Rosner B, Speizer F. A prospective study of diet and adult- onset asthma. Am J Respir Crit Care Med 1995;151: 1401. 82. London SJ, Connolly JL, Schnitt SJ, Colditz GA. A prospective study of benign breast disease and the risk of breast cancer. JAMA 1992:267:91. 83. Colditz GA, Willett WC, Hunter DJ, et al. Family his- tory, age and risk of breast cancer: Prospective data from the Nurses' Health Study. JAMA 1993;270:338. " 84. Green A, Willett WC, Colditz GA, et al. Use of per-

62 manent hair dyes and risk of breast cancer. J Natl Cancer Inst 1987;79:253. 85. Rosner B, Colditz GA, Willett WC. Reproductive risk factors in a prospective study of breast cancer: The Nurses" Health Study. Am ] Epidemiol 1994;139:819. 86. Manson J, Stampfer M, Colditz G, et al. A prospec- tive study of aspirin use and primary prevention of cardiovascular disease in women. JAMA 1991;266: 521. 87. Manson JE, Colditz GA, Stampfer MJ, et al. A prospec- tive study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch Intern Med 1991;151:1141. 88. Rich-Edwards J, Manson J, Stampfer M, et al. Height and the risk of cardiovascular disease in women. Am ] Epidemiol 1995;142:909. 89. Kawachi I, Colditz G, Stampfer M, et al. Prospective study of shift work and risk of coronary heart disease in women. Circulation 1995;92:3178. 90. Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Speizer FE, Willett WC. A prospective study of fam- ily history, age, and diet and colorectal cancer. N Engl J Med 1994;331:1669. 9~. Martinez ME, Giovannucci E, Spiegelman D, et al. COLDITZ ET AL. Physical activity, body size, and colorectal cancer in women. Am J Epidemiol 1996;143:$73. 92. Hemenway D, Feskanich D, Colditz G. Body height and hip fracture: A cohort of 90,000 women. Int J Epidemiol 1995;24:783. 93. Manson JE, Rimm EB, Stampfer MJ, et al. A prospec- tive study of physical activity and the incidence of non-insulin-dependent diabetes mellitus in women. Lancet 1991;338:774. 94. Hankinson SE, Hunter DJ, Colditz GA, et al. Tubal ligation, hysterectomy and risk of ovarian cancer: A prospective study. JAMA 1993;270:2813. 95. Weinstock MA, Colditz GA, Willett WC, et al. Non- familial cutaneous melanoma incidence in women is associated with sun exposure before 20 years of age. Pediatrics 1989;84:199. Address reprint requests to: Graham A. Colditz, M.D. Nurses" Health Study Channing Laboratory 181 Longwood Avenue Boston, MA 02115