AJPH EDITORIALS

APHA Voices From the Nurses’ Health Study Forty years ago, 121 700 US nurses responded to the call of the Nurses’ Health Study (NHS). In other articles of the issue we provide statistics about the extraordinary commitment and fidelity that these nurses demonstrated toward this pioneer cohort study. To translate these statistics into words we present here a set of testimonies from APHA members who participated in the NHS. Some of them belonged to the original NHS, some are daughters of nurses of the original NHS who joined the NHS II, and some have children enrolled in the offspring cohort named Growing Up Today Study (GUTS). They reveal the fabulous human dimension underlying this successful epidemiological study. Patricia J. Kelly, PhD, MPH, APRN, Professor, School of Nursing and Health Studies at the University of MissouriKansas City, and Chair of the Pubic Health Nursing Section of the APHA, sent the following e-mail to the nurse members of the Section: To celebrate the 40th Anniversary of the Nurses’ Health Study, Dr. Alfredo Morabia, MD, PhD, Editor of the American Journal of Public Health, would like to hear about experiences of nurses who have participated in the study. He is particularly interested in hearing about why nurses volunteered, what their experiences were, and what their feelings about the findings have been.

Here are snippets of the answers received (in alphabetic order of first names.)

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MOTHER AND TWO DAUGHTERS PARTICIPATED I have been part of the Nurses II study group. My mother and my 2 daughters have also participated. I was invited to participate when I was in graduate school, and knowing how hard it is to recruit participants I volunteered. I thought it was clever to invite nurses who would probably have a better health history recall to be in the study. I have enjoyed reading the variety of results that have been generated. —Cynthia, Indianapolis, IN

I VIEW THE FINDINGS AS SUSPECT Hello, I have been a participant in the first nurses’ study since the beginning. I choose to participate since I felt that my participation would contribute to the nation’s knowledge of health risk behaviors and health outcomes. First of all, many of the initial surveys asked for information which could only be answered prospectively, e.g. about diet when you were growing up, health behaviors practiced during childhood, etc. The answers I gave, and likely many of the participants gave, were only estimates of these behaviors and crude estimates at that. There were so many questions asked that really could not be answered definitively, yet the researchers used these answers to predict health outcomes. Thus, I have been somewhat disappointed in the overstatement of the results of the analyses and as a participant in the research, I view the findings as suspect. —Janet, Los Angeles, CA

A LEGACY FOR GENERATIONS TO FOLLOW I am one of the originals enrolled in the Nurses’ Health Study. Why did I enroll? I value women’s health and knew that women were not involved in major studies in 1976. I also “knew” that nurses would be invested in this ongoing study. Now 40 years strong, enrolled nurses (including other cohorts) have demonstrated to the research community their commitment to and value of research OVER TIME. The findings are meaningful. The findings (from women who honestly report and document their health, their behaviors and changing medical status) is a legacy for generations to follow. The one wish I still have is that an individual could access some of the data—especially the toe nail clippings and blood samples! Our daughters and their children should be invited to participate. —Katherine, Philadelphia, PA

OPPORTUNITY TO SHARE FOND MEMORIES I have been a participant in the Nurses’ Health Study since the late 1980s. I cannot recall why I initially participated but I think I was a graduate student and one of my professors told us about the study and that they were enrolling nurses. This

would have been around 1988–89. I especially recall the forms that I needed to complete with my Mom, discussing my early nutrition and some other health behaviors. I had not had such conversations with my Mom so the research actually provided an opportunity for us to share some fond memories like eating lunch at home every day during my high school years and the lunches she would make for me to take to school during other years. They were the best! I also helped her complete a form that was about the health of participants’ mothers; she had some trouble w/it so I was very happy to help her complete it. She felt so proud that she could participate too and maybe help another person improve their health. My Mom has been dead 7 years now but I still recall very fondly the conversations generated by the research forms. —Mary, Eu Claire, WI

AN ACTIVITY THAT HAS THE BIGGEST IMPACT What a great idea for an article! I often say that my participation in the Nurses’ Health Study will probably be an activity that has the biggest impact on others. —Mary Ann, Saint Louis, MO

PART OF SOMETHING BIGGER THAN MYSELF I have been participating in NHS 3 for several years now. I learned about the important contributions of NHS in

ABOUT THE AUTHOR Alfredo Morabia is the Editor-in-Chief of AJPH, Washington, DC. Correspondence should be sent to Alfredo Morabia, MD, PhD, Barry Commoner Center for Health and the Environment, Queens College, CUNY, 65-30 Kissena Boulevard, Flushing NY 11367 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This editorial was accepted July 4, 2016. doi: 10.2105/AJPH.2016.303370

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AJPH EDITORIALS

Nursing School. When I started to work as a nurse and realized there was an opportunity to participate in the research that 2 generations of nurses who came before me have contributed to, I was thrilled! I remain a proud participant and a vocal supporter of NHS 3 today. I enjoy feeling that I am a part of something bigger than myself, and potentially contributing information that could inform - transform our understanding about health and disease in the future. —Michelle, Ambler, PA

FOLLOWED ME AS MY CAREER UNFOLDED It was clear in my graduate epidemiology courses that women were under-represented in research and much of what we were learning about chronic disease and drug effectiveness was studied using male subjects and findings assumed to apply to women. I had been steeped in the history of professional nursing’s engagement with the Suffragette

Movement. Lavinia Dock, who was jailed a number of times for picketing with the National Women’s Party, joined my list of nursing leaders with whom I would love to dialogue if that “time machine” ever came to fruition. I admired our early nursing leaders and vowed to emulate the courage, commitment and engagement of our early nursing leaders. As a graduate student, I read Ashley’s book, Hospitals, Paternalism, and the Role of the Nurse. This book really solidified my perspective that in addition to nurses being strong advocates for their patients/clients, they also needed to be a strong voice for the field of nursing. So along comes this opportunity to participate in a longitudinal study that would collect data from nurses who were primarily women. It also made sense to me that such a cohort would be able to more precisely report data and to sustain interest in participation so the likelihood of robust data seemed golden! Those NHS envelopes of a characteristic size followed me around the country as my career unfolded. In some ways I miss the symbolism of those envelopes now that data reporting is

electronic. —Pam, West Lafayette, IN

A ROBUST SAMPLE OF COMPLIANT SUBJECTS I was pleased to join the NHS I in 1976, the original sample, and have faithfully answered every questionnaire and offered nail, hair clippings and blood samples. I assume my name was found in Registered Nurse listings for Connecticut. This study is the first and maybe the only, one that focuses mostly on women’s health issues with a robust sample of compliant subjects! I see my own contribution as important for that reason, now 40 years and counting! —Ruth, Cheshire, CT

THE SURVEY IS A PUBLIC HEALTH SERVICE I am in Nurses’ Health Study II. I feel as though I have

A Public Health of Consequence: Review of the September 2016 Issue of AJPH In this issue, we celebrate two interconnected themes: an editorial by Barbara Rimer1 and a host of articles produced from the rich Nurses’ Health Study data sets.

STUDENTS First, we start by endorsing Rimer’s call for the way forward to ensure that we focus on the public health research of consequence: the proper education of

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our students.1 Rimer urges us to talk the talk and walk the walk as we, the current public health researchers and educators, are the role models and the conduit of knowledge for our students. She focuses on nine elements that we can practice daily as we engage with our students, and here, we highlight a few. She advocates helping students focus on achieving positive impact for the greatest health threats, altering the morbidity and mortality

trajectories, and being able to articulate the costs on both sides of the ledger. To do that, we must be prepared to provide our students with the corresponding

“grown-up” with the NHS, as my 91 year old mother, also a nurse is in the original 1976 cohort. She would tell me about this “big nurses study from Harvard” that she was participating in, the questions that she answered, and the samples that she sent - I remember being particularly surprised by the toenail clippings. When I received the request to participate in NHS II, I willingly agreed and have sent hair and urine samples myself. I continue to believe it is a privilege and a responsibility to add to the body of knowledge to promote women’s health. I have appreciated the newsletters that are sent with the study findings and completing my NHS survey has become a summer ritual while sitting in the hammock in my backyard. My sons are also in the GUTS study and I have tried to instill in them that accurately completing the survey is a public service. —Ruth, Villanova, PA

Alfredo Morabia, MD, PhD

necessary research skills and tools, and stress the importance of quality measurement to demonstrate change. She stresses that our students need big data tools, data visualization methods, and great communication skills. Finally, among other elements, she also acknowledges that our students need to understand the state of the art in the selected topic area: What does the evidence

ABOUT THE AUTHORS Sandro Galea is Dean and Professor, School of Public Health, Boston University, Boston, MA. Roger Vaughan is an AJPH editor, and is also the Vice Dean and Professor of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY. Correspondence should be sent to Roger Vaughan, Vice Dean and Professor of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032 (e-mail: [email protected]). Reprints can be ordered at http://www. ajph.org by clicking the “Reprints” link. This editorial was accepted June 22, 2016. doi: 10.2105/AJPH.2016.303346

Galea and Vaughan

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APHA Voices From the Nurses' Health Study.

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