Voices from the Hilo Women's Health Study: talking story about menopause.

Our purpose in conducting this qualitative study was to examine how a multiethnic sample of women living in Hilo, Hawai'i, describe menopause. Interviews were conducted with 185 pre-, peri-, and post-menopausal women aged 45 to 55. We found that pre-menopausal women felt anxious compared with peri- and post-menopausal women's more affirmative attitudes of increasing confidence and freedom in this new cycle of life. A dominant theme was the construction of a post-menstrual identity. Peri-and post-menopausal women's attitudes were not biomedically oriented. Local culture and the island lifestyle may provide a positive atmosphere for women going through menopause.

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.

A comparison of awake-sleep blood pressure variation between normotensive Japanese-American and Caucasian women in Hawaii.

OBJECTIVE: To compare awake-sleep ambulatory blood pressure variation between Japanese-American and Caucasian women in Hawaii, specifically determining whether Japanese-Americans have reduced dipping of blood pressure during sleep, as is found in comparisons of Japanese and US samples. METHODS: Normotensive school teachers from East Hawaii who were either of Japanese-American (n = 70) or Caucasian (n = 48) ethnicity were recruited. They wore an ambulatory blood pressure monitor (Spacelabs 90207) that took measurements every 15 min during waking hours and every 30 min during sleep for a 24-h period on a normal workday. All subjects provided demographic information and underwent a series of anthropometric measurements the day before monitoring. Japanese-American subjects also answered questionnaires relating to cultural identity and migration history. RESULTS: The Japanese-American women had significantly higher mean diastolic (P < 0.01) blood pressure during sleep. These ethnic differences in sleep blood pressure persisted when analyses controlled for age, body mass index, and the waist-hip circumference ratio. There were also significant differences in the proportion by which blood pressure dipped from waking to sleeping, with the Japanese-American women dipping significantly less than the Caucasian women (P < 0.05 systolic, P < 0.001 diastolic). CONCLUSIONS: Normotensive Japanese-American women have higher sleep pressure, and a smaller awake-sleep dip, in pressure than Caucasian women. The relative elevation of blood pressure in Japanese-American women during sleep, but not at other times of the day, is similar to the pattern seen among Japanese women in Japan.

Incorporating Yup'ik and Cup'ik Eskimo traditions into behavioral health treatment.

The Yup'ik and Cup'ik Eskimo of Southwest Alaska have developed programs to provide healing from historical trauma. The Village Sobriety Project, a Center for Substance Abuse Treatment-funded project administered by the Yukon-Kuskokwim Health Corporation from 1999 to 2002, is an effort to incorporate the local Yup'ik and Cup'ik peoples' ways into treatment services for mental health and substance abuse. Activities such as tundra walks and time with elders are supported in treatment, and Medicaid reimbursement was successfully obtained for such activities. Documentation of treatment showed that it incorporated cultural elements of the Yup'ik and Cup'ik people.

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 chi 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.

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%; chi(2) = 6.9, P < 0.01; monitored sample: JAs, 26.1%; EAs, 46.6%; chi(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%; chi(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%; chi(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.

Exhaled nitric oxide decreases upon acute exposure to high-altitude hypoxia.

Nitric oxide (NO) is a vasodilator that plays a role in blood flow and oxygen delivery. Acute hypoxia down regulates NO synthesis, a response that may exacerbate hypoxic stress by decreasing blood flow. This study was designed to test the hypotheses that pulmonary NO decreases upon acute exposure to high-altitude hypoxia and that relatively low levels of NO at altitude are associated with greater stress as reflected in more symptoms of acute mountain sickness (AMS). A sample of 47 healthy, adult, nonsmoking, sea-level residents provided measurements at sea level, at 2,800 m, and at 0-, 2-, and 3-h exposure times at 4,200 m altitude on Mauna Kea, Hawaii. Measurements were made of exhaled NO, oxygen saturation of hemoglobin, heart rate, and reported symptoms of AMS. The partial pressure of NO concentration in exhaled breath decreased significantly from a sea level mean of 4.2 nmHg to 3.8 nmHg at 2,800 m and 3.4 nmHg at 4,200 m. NO concentration in exhaled breath did not change significantly over a 3-h exposure at 4,200 m and recovered to pre-exposure baseline upon return to sea level. There was no significant association between the level of NO exhaled and the number of self-reported symptoms of AMS during this brief exposure.