To Your Health
Nurses’ health study spanning almost two decades
contributes to advancement of women’s health care

By Linda Childers
January 17, 2005

For Abbey Alkon, RN, PhD, the Harvard Nurses’ Health Study is more than just an important research tool. It’s also a family affair. Not only is Alkon a participant in the study, but her mother and daughter also have contributed information.

The Harvard Nurses’ Health Study represents one of the largest prospective studies investigating risk factors for cancer, heart disease, dementia, and other chronic diseases in women. It began in 1976, with 121,000 nurses ranging in age from 30 to 55, who live in the 11 most populous states.

Today, more than 200,000 nurses throughout the country participate in the study, the longest-running study of women’s health in the world.

For nurses such as Alkon, the study’s findings yield important information on women’s health care issues. In the past year, the study released data on issues ranging from the health effects of postmenopausal hormones to preventing osteoporosis — information that study investigators would like to see used by nurses to improve their own health as well as that of their patients.

Alkon, associate professor in the department of family health care nursing at the University of California, San Francisco, says the study findings have helped her take a closer look at her own self-care habits.

“After reading the study data on osteoporosis, I have begun taking a calcium supplement,” Alkon says. “I also try to exercise three times a week based on study results that show that regular exercise can help prevent heart disease, obesity, breast cancer, and osteoporosis.”

Alkon also regularly shares study findings with the 140 students she teaches each year in her “Research Methods” course, part of the master’s program at the UCSF School of Nursing.

A study participant since 1981, Alkon notes that her mother, who is also a nurse, has contributed to the study for the past 20 years. Alkon’s teenage daughter recently enrolled in a new study looking at teenagers whose mothers are nurses.

“I truly believe that this is one of the most important health studies in the United States,” Alkon says. “Because there are so many nurses and we are compliant with completing forms, we can provide data needed to understand many common health problems. I hope this data will help us find the etiology of breast cancer along with many of the other diseases that affect women.”

Helping to shape science

Sue Hankinson, RN, ScD, senior investigator for the Nurses’ Health Study, finds her work on the project to be highly rewarding.

“We have a stellar group of participants who have been working with us for many years,” Hankinson says. “We have a participation rate of over 90%, and because of the information provided to us, we’re able to research myriad health issues.”

In addition to regularly filling out questionnaires, study participants also are asked to submit toenail clippings and blood samples, which investigators use to identify dietary mineral intake, potential biomarkers, hormone levels, and genetic markers.

“We see a lot of central themes reinforced through our study,” Hankinson says. “Much of our data has shown time and time again how being overweight can lead to heart disease, colon and breast cancers, an increased risk of cataracts and gallstones, and also have an adverse effect on a woman’s fertility.”

Hankinson also cites data that have shown the importance of regular exercise.

“Moderate weight-bearing exercise such as walking has been shown to decrease risk of diabetes, heart disease, and osteoporosis,” Hankinson says. “Our study showed that women who walked at least four hours a week had a 40% reduction in the risk of hip fractures. For postmenopausal women, walking eight hours a week provided the same protection against fractures as hormones did, while also lowering the risk of heart disease, diabetes, and stroke.”

Hankinson says that some of the study’s most interesting current research is looking at early life events and the effect they have on a woman’s health as she ages.

“We have some preliminary evidence showing that women who consumed higher levels of vitamin E when they were younger may have a decreased risk of developing breast cancer,” Hankinson says. “This is an area we are researching further in order to confirm these findings.”

Another new development is a possible link between women who have a high intake of fruit and vegetables, and a decreased risk of macular degeneration.

“This was the first time this has ever been reported so it’s very exciting,” Hankinson says. “It was a fairly robust finding, but once again we hope to delve further to confirm our initial data.”

Hankinson hopes that even nurses who are not involved in the study will use the data to help improve their own health and use the information as a patient education tool.

Sharing data with peers and patients

Mimi Haberfelde, RN, MS, AOCN, education coordinator of the VA Nursing Outcomes Database project at the San Francisco VA Medical Center, has participated in the Nurses’ Health Study II since its inception in 1989.

She notes that being a participant in the study has helped her to keep abreast of cutting-edge women’s health information.

“I’ve definitely learned critical information such as the impact of hormones in postmenopausal women and how they impact the incidence of stroke, blood clots, heart disease, and cancer,” she says. “I also feel more knowledgeable about prevention strategies for osteoporosis.”

Haberfelde appreciates the study’s annual newsletters that discuss recent findings in a user-friendly way.

“The last newsletter talked about osteoporosis prevention and the importance of vitamins D and K,” she says. “This is information that can be used by nurses and shared with patients. The study makes it easy for nurses to share the latest research findings, and also lists sources if they want additional information.”

For Rebecca Steinmann, RN, MS, CEN, CCRN, CCNS, clinical educator for the emergency department at Children’s Memorial Hospital in Chicago, participating in the study has proved to reinforce many of her own health beliefs.

“I’m at the same weight I was 25 years ago,” she says. “I’ve always tried to eat healthily and exercise, and when I read the study data, I feel encouraged that my lifestyle will have a positive impact on my future health.”

Steinmann also commends the study for giving both nurses and patients a broader picture of issues affecting women’s health.

“Many of the earlier health studies didn’t involve women,” Steinmann says. “This study has tracked many of the same nurses from their early 20s into middle age, giving all women a body of knowledge on what they can do to stay healthy.”

The Nurses' Health Study recently collaborated with colleagues at Harvard University to launch a new website, "Your Disease Risk," that builds on research from the Nurses' Health Study. The interactive site offers visitors personalized tips for lowering their risk of five major diseases: cancer, heart disease, stroke, diabetes, and osteoporosis.

To learn more, visit, www.YourDiseaseRisk.harvard.edu.

To read more about the Nurses' Health Study online, visit www.channing.harvard.edu/nhs.