Nurses’ Health Study (n=121,700)

Health Professionals Follow-up Study (n=52,000)

Nurses’ Health Study II (n=116,000)

Investigators: Frank Hu, Frank Speizer, Bernie Rosner, Meir Stampfer, Graham Colditz, David Hunter, JoAnn Manson, Sue Hankinson, Eric Rimm, Edward Giovannucci, Alberto Ascherio, Gary Curhan, Charlie Fuchs, Fran Grodstein, Michelle Holmes, Donna Spiegelman

1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2010

DietOcsSmokingWeight/HtMed. Hist.

Diet Diet DietBlood

Diet Diet

1986 1988 1990 1992 1994 1996 1998 2000 2010

Diet Diet DietBlood

Diet

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009

Diet Diet Diet

0.198a

Nails

Nails

Blood

1.50

1.85

1.061.00

1.39 1.41

1.00 1.11

0.0

0.5

1.0

1.5

2.0

2.5

<1/ mo 1-4/ mo 2-6/ wk >=1/ dSugar-sweetened soft drink consumption

Rel

ativ

e R

isk

multivariate adjusted multivariate + BMI

P<0.001 for trend

Regular Soft Drinks and Type 2 Diabetes, NHS2

(Schulze et al. 2004 JAMA)25.080

100

80

60

40

20

0

-20

-40

1%E 2%E 3%E 4%E 5%E

Trans

Sat

Mono

Poly

% C

ha

ng

e in

CH

D

Hu FB, et al. N Engl J Med 1997;337:1491-99.131

Type of Dietary Fat and Risk of Coronary Heart DiseaseThe Nurses' Health Study

14-Year Follow-up

Percentage of Type 2 Diabetes Potentially Preventable by Simultaneous Reduction of Five Modifiable Risk

Factors (NHS) (Hu et al.)

Low Risk1. Nonsmoking2. BMI < 253. Moderate to vigorous exercise4. Diet score in upper 40% (low trans fat, high cereal fiber, low glycemic load, high P:S ratio)5. Alcohol 5+ grams/day

Percent in low risk group: 4.1%Population attributable risk (PAR): 92% (82-96)

25.026R

29.446

29.443

MACROSYSTEM(Society)

Agricultural & Economic

Policies

FoodProduction

& Distribution

Restaurants

Parks & Playgrounds

PHYSICAL

ENVIRONMENT(Community Settings)

SOCIALENVIRONMENT

INDIVIDUAL

Worksites

Malls

VendingMachines

Food Access & Availability

Coworkers Friends

Grocery Stores

Social Norms

Culture

Family

Schools

FastFood

Media & Entertainment

(Print, TV, Web, Mobile)

Food&

Beverage Industry

Advertising

•Psychosocial•Lifestyle•Biologic

Health Clinics

Architectural Policy

(Zoning)

Exercise Facilities

Adapted by L Cheung

MediaRole

Models

Convenience Stores

Sidewalks

Bike Paths

RecreationPolicy

EducationalPolicy

TransportationPolicy

Health CarePolicy

Factors Influencing Individual Behavior

29.213a