Daniel E. Brown

Physiological stress responses in Filipino-American immigrant nurses: the effects of residence time, life-style, and job strain.

Objective The purpose of this study was to evaluate the relationship between measures of Americanization (the adoption of American life-style and culture) and physiological measures of stress in Filipino-American immigrants. Methods Ambulatory blood pressure monitors and timed urine collections were used to evaluate blood pressure and urinary catecholamine excretion across the work, home, and sleep daily settings among 31 healthy, premenopausal, immigrant Filipino-American women employed as nurses or nurse’s aides. Migration history and life-style were evaluated from questionnaire responses. Reported job strain, decision latitude, and psychological demand were obtained from the Job Content Questionnaire. Results Immigrants who had lived longer in the United States had elevated norepinephrine levels in the work and home settings ( p < .05), higher diastolic blood pressure during sleep (p < .01), and lower dips in blood pressure during sleep (p < .05). Job strain measures were not related to blood pressure, catecholamine excretion rates, or residence time in the United States. Conclusions The results suggest that indicators of stress increase as a function of time since immigration, although this result is not explained by self-reports of identification with Filipino or American life-style or by measures of job strain.

Do Japanese American women really have fewer hot flashes than European Americans? The Hilo Women's Health Study

Objective: Many studies have found a significantly lower frequency of reported hot flashes (HFs) in Japanese and Japanese American (JA) populations, leading to speculation about possible dietary, genetic, or cultural differences. These studies have relied on subjective reports of HFs. Accordingly, the purpose of this study was to compare both reported and objective HFs measured by sternal and nuchal skin conductance among JA and European American (EA) women. Methods: Two surveys of HF frequencies were carried out among women of either EA or JA ethnicity; aged 45 to 55 years; living in Hilo, Hawaii; and not using exogenous hormones. The first was a postal questionnaire (n = 325); the second was carried out during a clinical study of HFs (n = 134). Women in the second group underwent 24-hour ambulatory and 3-hour laboratory monitoring for objective HFs measured through skin conductance at sternal and nuchal sites. Subjective HFs were recorded on the monitor or in a diary. Results: JAs were significantly less likely to report having had HFs in the previous 2 weeks compared with EAs (postal sample: JAs, 30.9%; EAs, 43.9%; &khgr;2 = 6.9, P < 0.01; monitored sample: JAs, 26.1%; EAs, 46.6%; &khgr;2 = 5.3, P < 0.05). JAs were also significantly less likely to report experiencing other symptoms (15 of 30 in the postal sample; 6 of 30 in the monitored sample) than EAs. However, JAs did not significantly differ in likelihood of reporting subjective HFs during the 24-hour ambulatory period (JAs, 51.1%; EAs, 55.8%; &khgr;2 = 0.3, NS), nor in percentage of individuals displaying one or more objective HFs as measured by the skin conductance monitor (JAs, 77.8%; EAs, 72.1%; &khgr;2 = 0.5, NS). JAs also did not have a significantly fewer number of objective HFs (t = 0.2, NS) nor of subjective HFs (t = 0.8, NS) during the monitoring period, and these results were unchanged when analyses controlled for menopause status and body mass index. Conclusions: The common finding of fewer reported HFs in people of Japanese ancestry may be a consequence of reporting bias: JAs report fewer symptoms of many conditions compared with people from other ethnic groups. This is probably due to cultural conceptions of what is appropriate to report.

Vasomotor symptoms among Japanese-American and European-American women living in Hilo, Hawaii

Objective: The Hilo Womens Health Survey was designed and administered to gather baseline data on womens health in Hilo, HI. This randomized, cross-sectional study allowed for a focus on ethnic differences in symptom reporting. The results presented here focus on hot flash and night sweat experience among Japanese-American and European-American women. Design: Survey packets were mailed to street addresses associated with parcel numbers pulled randomly from Hilo tax maps. Of the 6,401 survey packets delivered to households, 1,824 questionnaires were completed and returned. The results reported here are based on 869 women aged 40 to 60, of whom 249 described themselves to be 100% Japanese and 203 described themselves to be 100% European-American. Logistic regression analyses were used to examine whether the relationship between ethnicity and vasomotor symptoms persisted after controlling for other variables. Results: European-American participants were more likely to have ever experienced a hot flash as compared with Japanese-American participants (72% vs 53%, P < 0.01). During the 2 weeks before the survey, European-American participants were more likely to have experienced hot flashes (P < 0.05) and night sweats (P < 0.01). In logistic regression analyses, after controlling for age, body mass index, menopause status, level of education, financial comfort, smoking habits, alcohol intake, exercise, use of hormone therapy, and soy intake, European-American women were still significantly more likely to have experienced hot flashes (odds ratio = 1.858) and night sweats (odds ratio = 2.672). Conclusions: The results, based on self-reporting of menopausal symptoms, indicate that Japanese-American women report fewer hot flashes and night sweats than European-American women. Japanese-American women reported a higher intake of soy, but soy intake was not associated with fewer vasomotor symptoms.

Physiological stress and culture change in a group of Filipino-Americans: a preliminary investigation

This preliminary survey evaluates the utility of physiological measures of general stress in anthropological fieldwork. The survey was conducted in a community of Filipino-Americans whose residents share similar housing conditions and low income levels but vary in ethnicity, migration status and degree of contact with Hawaiis urban culture. General stress levels are evaluated both by a subjective stress measure--the Cornell Medical Index (CMI)--and by physiological measures--twenty-four-hour excretion rates of norepinephrine, epinephrine and VMA. In addition, sociocultural data have been collected, and a culture contact index has been constructed. Preliminary results indicate that immigrants who have either low or high levels of contact with Honolulus urban culture have lower stress levels, as measured by catecholamine excretion, than individuals with intermediate levels of contact. These differences may be due to the presence of two strategies of urban adaptation, one emphasizing isolation from the urban culture and the other emphasizing just the reverse. Those people who do not successfully utilize one of these strategies are likely to have high stress levels. Additionally, significant ethnic differences in both CMI scores and degree of culture contact are noted, but there are no ethnic differences in catecholamine excretion. This is tentative evidence for the superiority of physiological measures over subjective reports of stress in a multiethnic setting.

Occupational Differences in Job Strain and Physiological Stress: Female Nurses and School Teachers in Hawaii

Objectives: The two objectives are to test the hypothesis that women in a profession with low decision latitude will have greater catecholamine excretion and higher blood pressure than women in a profession with greater decision latitude, and to assess the influence of ethnicity on the occupational comparison. Methods: Premenopausal women who were either full-time teachers in public schools (teachers; N = 92) or nurses or nurse’s aides (nurses; N = 55) in East Hawaii who were not currently taking antihypertensive medication had ambulatory blood pressure (BP) and urinary catecholamine excretion measured over an approximate 4-hour period at work and home and over an approximate 8-hour period overnight. The women also filled out the Job Content Questionnaire (JCQ). Results: The nurses had significantly lower scores on the “decision latitude” subscale of the JCQ. After controlling for the effects of ethnicity, age, body mass index, JCQ subscale scores, smoking habits, and menopausal status in regression analyses, the nurses also had significantly higher mean systolic and diastolic BP both in work and home settings and higher mean rates of both norepinephrine and epinephrine excretion in all daily settings (p < .05). There were no significant ethnic differences in scores on the JCQ subscales, but Asian-Americans had significantly higher systolic BP in all daily settings and higher diastolic BP overnight (p < .05) than Euro-Americans. Conclusions: These results suggest that among professional women, physiological stress responses are significantly greater when occupation-related decision latitude is low (nurses) than when it is high (teachers). The physiological response to stress is carried over into the home and overnight settings when occupation-related decision latitude is low (nurses). Individual scores on the JCQ were not significantly related to physiological measures in this study, however. Inclusion of contrasting occupations may be necessary to properly evaluate the relationships between individually reported job strain and heightened physiological stress responses in studies of working women. JCQ = Job Content Questionnaire; BMI = body mass index; BP = blood pressure.

Stress and changing lifestyles in the Pacific: Physiological stress responses of Samoans in rural and urban settings

The lifestyles and social environments of Pacific Islanders have changed profoundly as a result of local development and migration to urban, cosmopolitan centers. These changes have often been accompanied by an increase in chronic diseases, alcoholism, and suicide. As a result, the health effects of psychological and physiological stress have become an increasing concern in Pacific Island nations and in countries with significant Pacific migrant communities. Several studies in the Samoan Studies Project have examined catecholamine excretion rates in order to understand how the behavioral, psychological, and environmental changes of modernization affect the physiological stress responses of young Samoan adults. The results of studies in rural and urban Western Samoa, American Samoa, and Honolulu, Hawaii show that several complex factors associated with urban, more cosmopolitan lifestyles tend to increase stress hormone levels. Specifically, lifestyle differences in physical activity, diet, and social interaction have significant independent and interactive contributions. These behavioral factors can lead to a high degree of day‐to‐day variability in catecholamine excretion. The implications of these findings for future research designs are discussed. However, the data suggest that it is a complex interaction of lifestyle factors, not any specific single factor, that determines the physiological stress responses of Samoans in different environments.

Effects of ethnicity and socioeconomic status on body composition in an admixed, multiethnic population in Hawaii

This study determined ethnic differences in anthropometric measures of a sample of adults in Hawaii, examining the effects of differing degrees of ethnic admixing and socioeconomic status (SES) on the measures. Adults who had attended elementary school in Hawaii underwent anthropometric measurements and answered questionnaires about their educational attainment, income, age, cultural identity, ethnic ancestry, and health. Individuals reporting Asian American cultural identity had significantly lower mean body mass index (BMI) and waist circumference (WC) than others, whereas those with Hawaiian/Pacific Islander cultural identity had significantly higher BMI and WC. Educational attainment, but not reported family income and age, was significantly related to BMI and WC, and differences in educational attainment accounted for the increased mean BMI and WC in Hawaiian/Pacific Islanders, but did not account for the lower mean BMI and WC among Asian Americans. Higher percentage of Asian ancestry was significantly correlated with lower BMI and WC, whereas higher percentage of Hawaiian/Pacific Islander ancestry was significantly correlated with increased BMI and WC. Differences in education accounted for the significantly increased BMI in participants with a higher percentage of Hawaiian/Pacific Islander ancestry, but did not entirely account for the lower BMI in individuals with a higher percentage of Asian American ancestry. These results suggest that the high rate of obesity and its sequelae seen in Pacific Islanders may be more a result of socioeconomic status and lifestyle than of genetic propensity, whereas the lower rates of obesity observed in Asian American populations are less directly influenced by socioeconomic factors. Am. J. Hum. Biol., 2009.

InterLACE: A new International Collaboration for a Life Course Approach to Women's Reproductive Health and Chronic Disease Events

Evidence from population-based studies of women increasingly points to the inter-related nature of reproductive health, lifestyle, and chronic disease risk. This paper describes the recently established International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease. InterLACE aims to advance the evidence base for womens health policy beyond associations from disparate studies by means of systematic and culturally sensitive synthesis of longitudinal data. Currently InterLACE draws on individual level data for reproductive health and chronic disease among 200,000 women from over thirteen studies of womens health in seven countries. The rationale for this multi-study research programme is set out in terms of a life course perspective to reproductive health. The research programme will build a comprehensive picture of reproductive health through life in relation to chronic disease risk. Although combining multiple international studies poses methodological challenges, InterLACE represents an invaluable opportunity to strength evidence to guide the development of timely and tailored preventive health strategies.

Diurnal rhythm and concordance between objective and subjective hot flashes: the Hilo Women's Health Study.

Objective: The aims of this study were to test for a diurnal pattern in hot flashes in a multiethnic population living in a hot, humid environment and to examine the rates of concordance between objective and subjective measures of hot flashes using ambulatory and laboratory measures. Methods: Study participants aged 45 to 55 years were recruited from the general population of Hilo, HI. Women wore a Biolog hot flash monitor (UFI, Morro Bay, CA), kept a diary for 24 hours, and also participated in 3-hour laboratory measures (n = 199). Diurnal patterns were assessed using polynomial regression. For each woman, objectively recorded hot flashes that matched subjective experience were treated as true-positive readings. Subjective hot flashes were considered the standard for computing false-positive and false-negative readings. True-positive, false-positive, and false-negative readings were compared across ethnic groups by &khgr;2 analyses. Results: Frequencies of sternal, nuchal, and subjective hot flashes peaked at 1500 ± 1 hours with no difference by ethnicity. Laboratory results supported the pattern seen in ambulatory monitoring. Sternal and nuchal monitoring showed the same frequency of true-positive measures, but nonsternal electrodes picked up more false-positive readings. Laboratory monitoring showed very low frequencies of false negatives. There were no ethnic differences in the frequency of true-positive or false-positive measures. Women of European descent were more likely to report hot flashes that were not objectively demonstrated (false-negative measures). Conclusions: The diurnal pattern and peak in hot flash occurrence in the hot humid environment of Hilo were similar to results from more temperate environments. Lack of variation in sternal versus nonsternal measures and in true-positive measures across ethnicities suggests no appreciable effect of population variation in sweating patterns.

Menarche age, fatness, and fat distribution in Hawaiian adolescents

Menarche age was assessed in 93 adolescent females in a sample of public schools in East Hawaii. Native Hawaiian girls had significantly lower reported age at menarche than non-Hawaiian classmates. Age at menarche was significantly correlated with total fatness as measured by the sum of six skinfolds in girls who had reached menarche at least 2 years previous to measurement. When fatness was controlled in comparisons, the ethnic differences were not significant. Fat distribution, independent of fatness, was also significantly related to age at menarche. Socioeconomic, cultural, and admixture variables were not significantly related to age at menarche. Adiposity appears to be both a cause and a consequence of early age at menarche, with the relationship dependent on the elapsed time between menarche and measurement. This suggests that studies relating body composition to age at menarche must carefully control for the time interval between measurement and the date of menarche.