Lynn A. Morrison

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.

The Menstrual Cycle and Sexual Behavior: Relationship to Eating, Exercise, Sleep, and Health Patterns

ABSTRACT Patterns of eating, exercise, sleep, and health were investigated across 180 menstrual cycles of 89 women who engaged in sex with a male (n = 45; cycles = 85), a female (n = 21; cycles = 37), or abstained from sex (n = 33; cycles = 58) from January 2005 to December 2007 (10 contributed to 2 groups). Cycles were divided into 5 phases based on their luteinizing hormone surges. Daily questionnaires and saliva for IgA and cortisol analyses were obtained. Women indicated that they ate more (p < .008) and did not sleep as well (p = .02) during their luteal and premenstrual phases. Participants were less likely to experience food cravings and did not satisfy their cravings when they were ovulatory (p < .001). Additionally, a greater proportion of lesbians skipped breakfast (p = .01) and exercised less than heterosexuals (p = .05). Sexually active women had lower cortisol and IgA levels than abstinent women (p = .02). Our study discovered, and confirmed, systematic differences in eating, sleeping, and health patterns across womens menstrual cycles.

Traditions in Transition: Young People’s Risk for HIV in Chiang Mai, Thailand:

Thailand is in the midst of a social and sexual transition that is affecting gender roles, sexual behavior, and, hence, risk for HIV. The continuation of past traditions, such as men having sex with commercial sex workers, coupled with an increasing acceptance of noncommercial premarital sex among young people, is fueling the AIDS epidemic. To examine young people’s potential risk for HIV, the author investigated their perspectives on sexual behavior and sexual networking, the continued acceptance of premarital sex with commercial sex workers, and perception of risk for HIV in Chiang Mai. This study suggests that a changing social environment and the response to the AIDS epidemic have resulted in new patterns of sexual behavior that might trigger the dissemination of HIV into a broader network.

Ceausescu’s Legacy: Family Struggles and Institutionalization of Children in Romania

The significant numbers of children in institutions were among the numerous problems with which post revolutionary Romania had to contend. Since the cataclysmic events of December 1989 when the dictator Ceausescu and his wife were executed, countless orphanages were uncovered across the countryside of Romania. Thousands of children whose families were unable to support them were the direct out-come of Ceausescu’s stringent pronatalist measures and economic policies. Without existing alternatives, the children were placed in orphanages with minimal medical and social services resulting in high mortality rates and developmental disabilities. Another residual effect of the Ceausescu regime was the high rate of HIV among the institutionalized pediatric population. This article describes the sociocultural context of the institutionalization of children. Based on ethnographic research in a small town with an orphanage for the “irrecuperables,” this article will examine the circumstances directly and indirectly responsible for the institutionalization of so many children and, in addition, the struggles and living conditions of families with disabled children and adults who remained at home.

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.

Determinants of Infant-Feeding Choice Among Young Women in Hilo, Hawaii

Our multicultural island community is unique in that many young mothers live in multigenerational households. In this qualitative study, we examined the factors that influenced young mothers’ infant-feeding practices in Hilo, a small rural town in the Hawaiian Islands. The study participants consisted of young mothers, health care professionals, and educators. Our findings suggest that both the young mothers mother and her partner are very influential in the infant-feeding decision. Many young women in our study bottle fed to obtain assistance in caretaking, and to facilitate public breastfeeding. Additionally, we explored young mothers views of sexuality and breastfeeding, and their health promotion implications.

Relationship between hot flashes and ambulatory blood pressure: the Hilo women's health study.

Objectives: To examine ambulatory blood pressure (BP) differences between women who report hot flashes (HFs) and those who do not, and to observe whether an objectively measured HF is associated with transient changes in BP. HFs have been associated with elevated BP, but studies have not examined the relationship between objectively measured HFs and blood pressure during normal daily activities. Methods: A sample of 202 women in Hilo, Hawaii, aged 45 to 55 years, were asked to fill out a questionnaire that included demographic information and an inventory of symptoms. The women underwent simultaneous 24-hour monitoring of ambulatory BP and HFs, at the same time keeping a diary that included mood and HF reports. Results: No significant difference was present in mean BP between women who reported having an HF during the last 2 weeks and those who did not. When measurements controlled for negative mood reports and posture, there was a highly significant elevation in Z scores of systolic BP when a measured, objective HF occurred within 10 minutes before a BP reading, and a significant elevation of Z scores of diastolic BP when a subjectively reported HF occurred within 10 minutes after a BP reading. Conclusions: These results suggest that objectively measured HFs precede transient elevations of systolic BP, but it is unclear if there is a causal relationship. These results also suggest that women experience subjective HFs within 10 minutes after a transient increase in diastolic BP. Again, the causal relationship is not understood. BP = blood pressure; HF = hot flash.

Age-Related Differences in Health Complaints: The Hilo Women's Health Study

ABSTRACT The purpose of this study was to determine the age distribution of health-related complaints and symptom groupings from a random postal survey carried out in the multi-ethnic city of Hilo, Hawaii. Symptom frequencies and factor analyses were compared across three age categories: < 40 (32%), 40–60 (48%), and > 60 years (19%), (n = 1,796). Younger women were most likely to report headaches, menstrual complaints, irritability, and mood swings. Women at midlife were most likely to report fluid retention, trouble sleeping, loss of sexual desire, vasomotor symptoms, and nervous tension. Older women reported the least number of symptoms overall. Using multiple linear regression, menopause status, ethnicity, and alcohol intake were significantly associated with the factor scores for symptoms of menopause, after controlling for age, education, BMI, exercise, smoking habits, and financial comfort.

Age at menopause and determinants of hysterectomy and menopause in a multi-ethnic community: The Hilo Women's Health Study

OBJECTIVES A lifespan approach was used to evaluate age at menopause, and determinants of surgical and natural menopause, in the multi-ethnic community of Hilo, Hawaii. STUDY DESIGN Participants aged 40-60 years (n=898) were drawn from a larger, randomly generated sample recruited by postal questionnaires. Median age at natural menopause was computed by probit analysis. Logistic regression analysis was applied to examine determinants of hysterectomy, and Cox regression analysis was used to examine risk factors for an earlier age at menopause. MAIN OUTCOME MEASURES History of hysterectomy, age at menopause. RESULTS Frequency of hysterectomy was 19.2% at a mean age of 40.5 years. The likelihood of hysterectomy increased with older ages, lower education, mixed ancestry, having been overweight at age 30, and married 20 years prior to survey. Median age at natural menopause was 53.0 years. Smoking and not being married 10 years before survey were associated with an earlier age at menopause. CONCLUSIONS Median age at menopause was later than the national average. Ethnicity and education were determinants of hysterectomy, but not associated with age at natural menopause. Events later in the lifespan (e.g., smoking and not being married 10 years prior to the survey) were more important than earlier events (e.g., childhood residence) in relation to age at menopause. The timing of weight gain and marital status appear to be important in relation to surgical menopause, and the timing of marital status appears to be important in relation to the timing of natural menopause.