A multidimensional appraisal of early menstrual pain experience.

BACKGROUND: Symptomatic dysmenorrhea is a global problem, affecting more than 40% of menstruating persons. Cross-sectional studies have implicated psychosocial, biological, and sensory factors in dysmenorrhea but the mechanisms are not fully understood. Only a few prospective longitudinal studies have evaluated such factors in relation to the emergence and course of dysmenorrhea at menarche. OBJECTIVE: This study aimed to describe the initial menstruation experience and to evaluate the association of premenarchal psychosocial and sensory factors with the intensity of dysmenorrhea during the period in the fourth month. STUDY DESIGN: This was a prospective cohort study of adolescents who completed premenarchal assessments and postmenarchal daily menstrual diaries for their first (n=149) and fourth month periods (n=114). They were recruited shortly before menarche and completed baseline assessments, including psychosocial questionnaires and experimental pain sensitivity (pressure testing, bladder provocation), and their parents completed related pain questionnaires. The relation between the hypothesized premenarchal factors and month 4 dysmenorrhea intensity was evaluated using Kruskal-Wallis and chi-square tests for low (<3 on a 0-10 scale) vs higher (≥3) menstrual pain groups based on maximal pain ratings recorded in a daily diary. RESULTS: Low levels of dysmenorrhea characterized the first (median, 1; interquartile range, 0-2) and fourth month periods (1; 0-3). Maximal pain ratings increased from the first to the fourth period (3; 1-5 vs 4; 1-6; P=.007). The distribution of dysmenorrhea was multimodal at month 4 with 31.6% of the participants having low levels of maximal pain (1; 0-1) and 68.4% having higher levels (5; 4-6; Hartigan's dip test P<.001). The baseline demographic, psychosocial, and parental pain characteristics were not associated with the development of worse dysmenorrhea. The baseline experimental pain sensitivity, based on pressure pain thresholds, did not differ between the low (15.7 N; 12.5-22.3) and higher (15.0 N; 10.9-21.4]) level dysmenorrhea groups. Baseline bladder pain at first urge also did not differ (low, 6; 0-20 vs higher, 7; 0-19). CONCLUSION: By their fourth month period, two-thirds of adolescents fell into the higher group for maximal dysmenorrhea, half reported some related impairments in physical activity, and one-seventh reported some related school absence. Premenarchal factors (experimental pain sensitivity, psychosocial profile, parental pain experience) linked to chronic pain emergence in the adult literature did not predict dysmenorrhea intensity, suggesting the dominant factor at menarche may be peripheral afferent activation. Further research is needed to understand the evolution of psychosocial and sensory mechanisms in the development and course of dysmenorrhea.

An ecological model of weight gain among school-age children.

OBJECTIVE: Childhood obesity rates remain historically high in the United States. One way to conceptualize the many factors that contribute to obesity is through the use of an ecological model. There is a particular need to adapt and test this type of comprehensive model among vulnerable racial/ethnic and socioeconomic groups. METHOD: Using a large sample of U.S. youth (n = 8,225) drawn from the ECLS-K:2011, this project applied an ecological model of childhood obesity from kindergarten to second grade, including factors such as child physical activity, child screen time, child bedtime, family physical activity, family food insecurity, family meals, and neighborhood safety. The contributions of each of these factors across racial/ethnic, socioeconomic, and income-to-needs groups were examined concurrently and longitudinally. RESULTS: Among the full sample, the largest standardized effect on weight was for income-to-needs ratio. Moving from above to below 200% of the poverty line resulted in an increase of .12 standard deviations in BMIz. Multigroup analyses indicated that there was only a significant difference in model fit based on race/ethnicity. Among Latino youth, income-to-needs ratio was a significant negative predictor of kindergarten BMIz; however, this effect was not significant among Black/African American youth. CONCLUSIONS: Overall, income-to-needs ratio emerged as the strongest link to obesity among the early elementary school years; this was particularly present among Latino youth. (PsycInfo Database Record (c) 2022 APA, all rights reserved).