1. 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 Diet Ocs Smoking Weight/Ht Med. Hist. Diet Blood Diet 1986 1988 1990 1992 1994 1996 1998 2000 2010 Diet Blood Diet 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 Diet 0.198a Nails Blood

2. Regular Soft Drinks and Type 2 Diabetes, NHS2 (Schulze et al. 2004 JAMA) 25.080

3. 100 80 60 40 20 0 -20 -40 1%E 2%E 3%E 4%E 5%E Trans Sat Mono Poly % Change in CHD Hu FB, et al. N Engl J Med 1997;337:1491-9 9.131 Type of Dietary Fat and Risk of Coronary Heart Disease The Nurses' Health Study 14-Year Follow-up

4. Percentage of Type 2 Diabetes Potentially Preventable by Simultaneous Reduction of Five Modifiable Risk Factors (NHS) (Hu et al.) Low Risk 1. Nonsmoking 2. BMI < 25 3. Moderate to vigorous exercise 4. 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

5. 29.446

6. 29.443

7. MACROSYSTEM (Society) Agricultural & Economic Policies Food Production & Distribution Restaurants Parks & Playgrounds PHYSICAL ENVIRONMENT (Community Settings) SOCIAL ENVIRONMENT INDIVIDUAL Worksites Malls Vending Machines Food Access & Availability CoworkersFriends Grocery Stores Social Norms Culture Family Schools Fast Food Media & Entertainment (Print, TV, Web, Mobile) Food & Beverage Industry Advertising Psychosocial Lifestyle Biologic Health Clinics Architectural Policy (Zoning) Exercise Facilities Adapted by L Cheung Media Role Models Convenience Stores Sidewalks Bike Paths Recreation Policy Educational Policy Transportation Policy Health Care Policy Factors Influencing Individual Behavior 29.213a