The additive model measures risk differences while the multiplicative model uses ratios to measure effects. The additive model has been suggested to be a better fit for predicting disease risk in a population while a multiplicative model is more appropriate for disease etiology. Epigenetics is an example of an underlying mechanism of gene–environment effects, however, it does not conclude whether environment effects are additive, multiplicative or interactive. Gene "×" environment "×" environment interactions New studies have also revealed the interactive effect of multiple environment factors. For example, a child with a poor quality environment would be more sensitive to a poor environment as an adult which ultimately led to higher psychological distress scores. This depicts a three way interaction Gene x Environment x Environment. The same study suggests taking a life course approach to determining genetic sensitivity to environmental influences within the scope of mental illnesses. Medical significance Doctors are interested in knowing whether disease can be prevented by reducing exposure to environmental risks. Some people carry genetic factors that confer susceptibility or resistance to a certain disorder in a particular environment. The interaction between the genetic factors and environmental stimulus is what results in the disease phenotype. There may be significant public health benefits in using gene by environment interactions to prevent or cure disease. An individual's response to a drug can result from various gene by environment interactions. Therefore, the clinical importance of pharmacogenetics and gene by environment interactions comes from the possibility that genomic, along with environmental information, will allow more accurate predictions of an individual's drug response. This would allow doctors to more precisely select a certain drug and dosage to achieve therapeutic response in a patient while minimizing side effects and adverse drug reactions. This information could also help to prevent the health care costs associated with adverse drug reactions and inconveniently prescribing drugs to patients who likely won't respond to them. In a similar manner, an individual can respond to other environmental stimuli, factors or challenges differently according to specific genetic differences or alleles. These other factors include the diet and specific nutrients within the diet, physical activity, alcohol and tobacco use, sleep (bed time, duration), and any of a number of exposures (or exposome), including toxins, pollutants, sunlight (latitude north–south of the equator), among any number of others. The diet, for example, is modifiable and has significant impact on a host of cardiometabolic