We identified 1008 individuals with incident distal colorectal adenoma 3–5 years after baseline, leaving 16 064 individuals with no abnormal/suspicious findings at both baseline and follow-up flexible sigmoidoscopies. Of the 1008 individuals with distal colorectal adenoma, 503 cases were non-advanced, 237 were advanced, and 268 were unknown for advanced status. A total of 131 individuals had multiple adenomas at follow-up and 772 had at least one adenoma in the distal colon, whereas 263 had at least one adenoma in the rectum (the specific location within the distal colorectum was unknown for 25 individuals). Individuals in the highest quartile of red meat were more likely to be non-Hispanic White and be current smokers compared with those in the lowest quartile of red meat consumption (Table 1). Participants who consumed the most red meat were also less likely to be female, less educated, and less physically active than those who consumed the least red meat.