摘要：Objectives. To summarize the overall impact of the Nurses’ Health Study (NHS) over the past 40 years on the health of populations through its contributions on prevention, translation, and control. Methods. We performed a narrative review of the findings of the NHS, NHS II, and NHS3 between 1976 and 2016. Results. The NHS has generated significant findings about the associations between (1) smoking and type 2 diabetes, cardiovascular diseases, colorectal and pancreatic cancer, psoriasis, multiple sclerosis, and eye diseases; (2) physical activity and cardiovascular diseases, breast cancer, psoriasis, and neurodegeneration; (3) obesity and cardiovascular diseases, numerous cancer sites, psoriasis, multiple sclerosis, kidney stones, and eye diseases; (4) oral contraceptives and cardiovascular disease, melanoma, and breast, colorectal, and ovarian cancer; (5) hormone therapy and cardiovascular diseases, breast and endometrial cancer, and neurodegeneration; (6) endogenous hormones and breast cancer; (7) dietary factors and type 2 diabetes, cardiovascular diseases, breast and pancreatic cancer, non-Hodgkin’s lymphoma, neurodegeneration, multiple sclerosis, kidney stones, and eye diseases; and (8) sleep and shift work and chronic diseases. Conclusions. The NHS findings have influenced public health policy and practice both locally and globally to improve women’s health. As noted in the individual articles in this series, the Nurses’ Health Study (NHS) has evolved to address a broad range of lifestyle factors through questionnaires and biomarkers, 1 including diet, hormones, and trace elements. The study has also expanded from its initial funding to address breast cancer to include many other chronic conditions: type 2 diabetes, cardiovascular disease, fractures, rheumatological conditions, eye diseases, and other endpoints of interest in women’s health. The NHS has informed an array of research areas including studies on obesity, kidney stones, skin conditions, less-common cancers, psychological factors (e.g., depression), and neurodegenerative diseases. This expansion adds to the return on investment building the rich NHS cohort data through funding by the National Cancer Institute. 2 It also requires a continuity of funding to support the breadth and validity of health outcomes. To enable these efforts, the NHS has experimented with diverse innovations in infrastructure to maximize effectiveness and cost-efficiency, with many of these logistical innovations becoming common practice for other large epidemiological studies. 3 One of the most significant contributions is the use of optically scanned questionnaires and linkage to the National Death Index to complement active follow-up. However, among the most significant innovations introduced in NHS was the repeated assessment of habitual diet. The NHS has made key contributions in nutritional epidemiology research with the creation and validation of the Harvard Semiquantitative Food Frequency Questionnaire. 4 This improved efficiency has enabled the NHS to create an exceptional, large database of comprehensive, long-term, multidimensional information. The use of data from prospective cohort studies such as the NHS has previously been addressed with regard to the overall impact of the National Cancer Institute–funded research program in cancer epidemiology. 5 That report focused primarily on the phases of the discovery, development, and delivery paradigm of cancer research. It also emphasized the importance of research findings from cohort studies and the need for their continued support. The existing National Cancer Institute–funded prospective cohorts, like the NHS, continue to provide key data that guide public health and clinical practice across many chronic conditions. 2 Evidence from cohort studies can help explain the etiology of disease with fewer sources of bias then other etiological designs. The broader contributions of cohorts in advancing our understandings of lifestyle and prevention of chronic conditions have been thoroughly summarized. 6,7 This article summarizes some of the distinct contributions of the NHS and how the cohort has adapted to changing public health issues. We used the framework of discovery, development, and delivery applied to epidemiology. 5 More extensive details are presented in the individual updates in this series.
