Cross-cultural comparison of women’s midlife symptom-reporting: a china study

Drawing on ethnographic and survey research conducted by the author in a general population sample in mainland China, this article presents findings on Chinese women’s midlife symptom reporting in comparison with pivotal studies conducted by Lock, Kaufert, and McKinlay in Japan, Canada, and the U.S. Analysis of the China survey data (N = 156 women, age 45–55) reveals for sixteen core symptoms a reporting frequency that is much lower than depicted in classic biomedical models of menopause. At the same time, however, the China data indicates problems with the popular extrapolation that midlife Asian women are virtually symptom-free compared to their North American peers. Finding the Chinese level of symptom-reporting low to moderate depending on the symptom, the article reveals important differences between Chinese and Japanese women in their level and pattern of symptom reporting, as well as substantial overlap with North American women in this regard. Referencing ethnographic materials on Chinese women and the cross-cultural literature on menopause, the article assesses potential explanations for the cross-cultural variation observed, including: local reproductive endocrinology, phytoestrogen consumption, aspects of East Asian culture, the nature of social change, the cultural acceptability of monitoring and voicing symptoms, and differences in dominant conceptions of midlife.     

Is There Adaptive Value to Reproductive Termination in Japanese Macaques? A Test of Maternal Investment Hypotheses

Evolutionary biologists often argue that menopause evolved in the human female as the result of selection for a postreproductive phase of life, during which increased maternal investment in existing progeny could lead to enhanced survivorship of descendents. Adaptive theories relating menopause to enhanced maternal investment are known as the mother (first-generation) and grandmother (second-generation-offspring) hypotheses. Although menopause—universal midlife termination of reproduction—has not been documented in primates other than humans, some researchers have argued that postreproductive alloprimates also have a positive impact on the survivorship of first and second generation progeny. We tested the maternal investment hypotheses in Japanese macaques by comparing the survivorship of offspring, final infants, and great-offspring of females that terminated reproduction before death with females that continued to reproduce until death. SURVIVAL analyses revealed no significant difference in the survivorship of descendents of postreproductive and reproductive females, though final infants of postreproductive females were 13% more likely to survive than final infants of females that reproduced until death were. We also explored possible differences between these two groups of females, other than survivorship of progeny. We found no difference in dominance rank, matrilineal affiliation, body weight, infant sex ratio, age at first birth, fecundity rate or lifetime reproductive success. However, postreproductive females are significantly longer-lived than reproductive females and as a result experienced more years of reproduction and produced more infants in total. Apart from final infants, offspring survival is marginally lower in postreproductive females. Since offspring survival is not significantly enhanced in postreproductive females, the greater number of infants produced did not translate into greater lifetime reproductive success. Our findings fail to support the maternal investment hypotheses and instead suggest that reproductive termination in this population of Japanese macaques is most closely associated with enhanced longevity and its repercussions.     

Impact of Breast Cancer on Asian American and Anglo American Women

This pilot study constitutes the first exploration ofthe impact of breast cancer on Asian American women.Three hypotheses guided this study: (1) Asian Americanwomen would choose breast conserving therapy andbreast reconstruction at a lower rate than the AngloAmerican women due to cultural differences in bodyimage, (2) Asian American women with breast cancerwould express psychological distress somatically andAnglo American women would express distress emotionally, and acculturation levels of the AsianAmerican women would modify the expressions ofdistress such that women with high acculturation willexpress distress more emotionally and lessacculturated women would express distress moresomatically, and (3) Asian American women would seekassistance for psychosocial problems at asignificantly lower rate than Anglo women. Ethnicity,age, and levels of acculturation were found to besignificant variables that had to be consideredsimultaneously. The three hypotheses were onlypartially supported: (1) Asian American women chosebreast conserving therapy and adjuvant therapy at asignificantly lower rate than the Anglo Americanwomen, (2) Contrary to the hypothesis, somatization didnot appear to be a dominant form of symptompresentation for Asian American women regardless oflevel of acculturation, and (3) Asian American womensought professional assistance for psychosocialproblems at a significantly lower rate than Anglowomen. Asian American women reported using differentmodes of help-seeking behavior for emotional concernsand receiving different sources of social support thanthe Anglo American women. Cultural interpretations ofthe findings are offered to explain the differences inthe physical, emotional, and social responses to thebreast cancer experience of Asian American womencompared with the Anglo Americans, and notably betweenthe Chinese- and Japanese Americans as well. Thefindings of this study warrant more refinedexploration in order to improve the medical,psychological and social outcomes for Asian Americanwomen with breast cancer.     

Ambiquities of aging: Japanese experience and perceptions of menopause

The initial findings of this study indicate that menopause is regarded as a natural life-cycle transition in Japan in which the biological marker of cessation of menstruation is not considered to be of great importance. Symptom reporting among all respondents is generally low regardless of menopausal status, and symptoms such as shoulder stiffness and headaches, which are reported frequently, are not linked specifically to menopausal status (even though individual informants may perceive them to be so). Symptoms of hot flashes and sudden perspiration are higher among peri- and post-menopausal women, but their prevalence appears to be much lower than research findings from other areas to date. Reports by Japanese gynecologists emphasize that menopausal women are liable to present with numerous non-specific somatic complaints. This may well be an accurate representation of a clinical population, but the findings of this present study indicate that such a picture is by no means representative of the average middle-aged female population in Japan. While occupational differences do not contribute to variation in reported symptomatology (with the exception of lumbago and shoulder stiffness), there are nevertheless considerable differences in the subjective meaning of menopause, many of which can be accounted for by class and occupational differences. Presentation of these differences awaits a future publication, but there is one topic which is of concern to the majority of the respondents from each of the sub-samples. The present generation of women entering their 50's are the first where the majority must face later middle age in a nuclear family, along with their husbands, although both they and their husbands have been socialized for the more distant male/female relationships of an extended family. Japanese women cannot look forward, as they did in the past, to the power and comforts derived from running an extended family; on the contrary many can expect a late middle age of looking after bed-ridden parents or parents-in-law, and a lonely, isolated and often poverty-stricken old age (Steslicke 1984), since many pension programs are by no means adequate. Some of their fears about aging are expressed in their views on menopause, but these fears do not appear to be manifested at all prominently as either psychological or somatic representations. When asked to compare their lives with that of their own mothers, stories of incredible hardships from pre- and immediately post-war Japan are vividly portrayed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Menopause and the transmission of women's knowledge: African American and white women's perspectives

Recent menopause literature does not sufficiently explore women's attitudes on the transmission of knowledge about menopause from sources other than biomedical providers. Analysis of 70 interviews with African American and Euro-American women shows that their perceptions of the intergenerational transfer of knowledge about menopause from their mothers shaped their attitudes toward menopause and the health-care technologies surrounding it. African American women who grew up in the segregated South frequently expressed that their mothers provided them with the knowledge and power to negotiate difficulties during the menopausal process, while many middle-class Euro-American women expressed that their mothers did not. Drawing on literature that examines the effects of race, class, and kinship on mother/daughter relationships, this article explores the reasons for this divergence.     

Comparison of Regional Fat Distribution and Health Risk Factors in Middle‐Aged White and African American Women: The Healthy Transitions Study

Objective: Both ethnicity and menopause appear to influence intra‐abdominal fat distribution. This study evaluated intra‐abdominal fat distribution and obesity‐related health risks in perimenopausal white and African American women. Research Methods and Procedures: Baseline data from a longitudinal study of changes in body composition and energy balance during menopause are reported. Healthy women (55 African Americans and 103 whites) who were on no medication and had at least five menstrual cycles in the previous 6 months were recruited. Body composition was assessed by DXA, and visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were assessed by computed tomography scan. SAT was divided into deep and superficial layers demarcated by the fascia superficialis. Results: African American women were slightly younger (46.7 ± 0.2 vs. 47.7 ± 0.2 years, p = 0.002) and fatter (42.4% ± 1.0% vs. 39.4% ± 0.8% body fat, p = 0.02) than white women. In unadjusted data, African Americans had significantly more total abdominal fat and total, deep, and superficial SAT than whites. After adjustment for percent body fat and age, only total and superficial SAT remained significantly higher in African Americans. VAT although slightly less in African American women, did not differ significantly by race. In multiple regression analysis, VAT was the strongest predictor of serum lipids, glucose, and insulin in women of both races, although superficial SAT was significantly associated with fasting glucose in whites. Conclusions: Middle‐aged African American women have larger SAT depots, adjusted for total body fatness, but do not differ from white women with regard to VAT. The complexity of the relationship between abdominal fat and metabolic risk is increased by ethnic differences in such associations.     

Racialized political shock: Arab American racial formation and the impact of political events

This article explores significant factors influencing the process of Arab American racial formation. I bring into conversation theories of racial formation and ‘political shock’ in social movement scholarship to develop the notion of ‘racialized political shock’ as an important factor in how racial and ethnic groups mobilize and organize. Many moments of political shock are highly racialized and have the potential to reorder the racial and ethnic landscape in ways that can open opportunities or introduce constraints to mobilizations around racial formation. Drawing on existing studies of Arab Americans, this paper highlights how Arab American racial formation has been galvanized during moments of racialized political shock. In the Arab American case, these moments have led to a call for recognition outside the category of white. I conclude by outlining ways forward in the study of Arab Americans, who have been overlooked in studies of race and ethnicity in the US.     

Racialized national identity construction in the ancestral homeland: Japanese American migrants in Japan

This article examines Japanese Americans in Japan to illuminate how ‘Japanese American’ – an ethnic minority identity in the US – is reconstructed in Japan as a racialized national identity. Based on fifty interviews with American citizens of Japanese ancestry conducted between 2004 and 2007, I demonstrate how interactions with Japanese in Japan shape Japanese Americans’ racial and national understandings of themselves. After laying out a theoretical framework for understanding the shifting intersection of race, ethnicity, and nationality, I explore the interactive process of racial categorization and ethnic identity assertion for Japanese American transnationals in Japan. This process leads to what I call racialized national identities – the intersection of racial and national identities in an international context – and suggests that US racial minority identities are constructed not only within the US, but abroad as well.     

Analysis of the African American female nose

The African American nose has been broadly classified as ethnic yet it differs significantly in morphology from that of other ethnic groups with which it is categorized. The objectives of this study were to (1) establish an objective protocol for analysis of the African American female nose using anthropometric measurements, and (2) determine whether subjective subcategorization schemes are a reliable replacement for anthropometry. African American women (n = 107) between the ages of 18 and 30 years consented to participate in this study. Photographs and 14 standard anthropometric measurements were taken of the face and nasal region, including nose length, nose width, special upper face height, intercanthal distance, mouth width, nasal bridge inclination, nasal tip protrusion, ala thickness, nasal root width, nasal bridge length, tangential length of ala, length of columella, nasofrontal angle, and nasolabial angle. Nasal indices including nose width-nose height index, nasal tip protrusion-nose height index, and nasal tip protrusion-nasal width index were calculated. In addition, photographic analysis was performed to evaluate nostril shape, nasal base shape, and nasal dorsal height. Proportional relationships and subcategorization schemes were evaluated. A new method of nasal analysis for the African American woman uses the proportional relationships of the anthropometric measurements. Proportional relationships included a columellar to lobule ratio of 1.5:1, a nasolabial angle of 86 degrees, and an alar width to intercanthal distance ratio of 5:4. The nasal dorsal height classification scheme was the most reliable for subjective analysis. The degree of variability found within this group of young African American women is illustrated by the following indices and their respective ranges: nose width-nose height index mean, 79.7 (range, 57 to 102); nasal tip protrusion-nose height index mean, 33.8 (range, 23 to 46); and nasal tip protrusion-nose width index mean, 42.8 (range, 32 to 61). The guidelines provided are a baseline from which to begin analysis and evaluation.     

Contesting "Culture": The Perspectives of Hmong American Female Students on Early Marriage

This article complicates the meanings of early marriage among Hmong American female students. It moves beyond explanations of cultural difference in the examination and explication of the discourse and practice of early marriage among female adolescents in the Hmong community. Drawing on the perspectives and experiences of Hmong American female students, this article reveals that early marriage may be an expression of students' opposition to the structures of and experiences with school and family. The significance of this analysis is its recognition and illumination of the fluidity of cultural and social practices, and the tensions between and within ethnic groups.     

Marriage promotion and missing men: African American women in a demographic double bind

Since 1996, state legislators, members of the U.S. Congress, and more recently President George W. Bush, have called for the protection of monogamous, heterosexual marriage and the promotion of marriage among poor women. The thrust of this policy making is directed at African American families, among which female headship doubled between 1965 and 1990. This doubling is temporally associated with enacting the legislation directed toward the War on Drugs, which resulted in a tripling of the African American prison population. In Syracuse, New York, the swelling African American population behind bars has resulted in a skewed sex ratio, in which women significantly outnumber men. The authors use national, state, and local epidemiological, environmental, and ethnographic data to argue that the proliferation of marriage-promotion policies is heterosexist and blames African American women for demographic realities over which they have little control.     

Blood and Nerves Revisited: Menopause and the Privatization of the Body in a Newfoundland Postindustrial Fishery

Ethnographic data from a longitudinal, interpretive study of women's changing social and cultural constructions of menopause in a postindustrial, Newfoundland fishing village indicate that three major changes have taken place in the way women conceptualize female, reproductive life-cycle events and processes. First, folk idioms of nerves and blood that once linked soma, psyche, place, and tradition are now trivialized and have been superseded by biomedical models of menopause. Second, physicians, television, magazines, and school teachers have replaced the community's middle-aged women and the mutual communication of shared experience as major sources of information and advice on reproduction and aging. Third, women's bodies have become privatized, and bodily metaphors that once linked women in complex individual and collective assessments of shared, highly valued traditions and mutual judgment of moral character have lost their dominance in village life. [menopause, Newfoundland, body image, sociocultural change, fishing]     

Earning the model‐minority image: Diverse strategies of economic adaptation by Asian‐American women

Using the 1980 US Population Census data, this article documents the diverse strategies of economic adaptation adopted by a group of working‐age immigrant women: Japanese, Chinese, Filipino, Korean, Indian and Vietnamese. A comparable sample of non‐Hispanic white women serves as the reference group. Striking heterogeneity in the individual and collective resources of these groups, together with differences in labour market opportunities and historical context of immigration, have led to a variety of patterns of labour force participation and methods of income attainment. In order to move beyond the oversimplified image of Asian‐Americans as a model minority in their economic success, the article applies four different theories to the census data ‐ assimilation, dual economy, ethnic‐enclave economy and middleman minority. The article closes with a discussion of theoretical implications and methodological suggestions for future studies concerning labour force position and economic adaptation of minority and immigrant women.     

Mate Choice and the Origin of Menopause

Human menopause is an unsolved evolutionary puzzle, and relationships among the factors that produced it remain understood poorly. Classic theory, involving a one-sex (female) model of human demography, suggests that genes imparting deleterious effects on post-reproductive survival will accumulate. Thus, a ‘death barrier’ should emerge beyond the maximum age for female reproduction. Under this scenario, few women would experience menopause (decreased fertility with continued survival) because few would survive much longer than they reproduced. However, no death barrier is observed in human populations. Subsequent theoretical research has shown that two-sex models, including male fertility at older ages, avoid the death barrier. Here we use a stochastic, two-sex computational model implemented by computer simulation to show how male mating preference for younger females could lead to the accumulation of mutations deleterious to female fertility and thus produce a menopausal period. Our model requires neither the initial assumption of a decline in older female fertility nor the effects of inclusive fitness through which older, non-reproducing women assist in the reproductive efforts of younger women. Our model helps to explain why such effects, observed in many societies, may be insufficient factors in elucidating the origin of menopause.     

Odontometric variation among American black, European, and Mongoloid populations

Quantified dental parameters (including root and pulp areas and shape variables) derived from periapical radiographs were used to make comparisons among a sample of American Black (8 males--124 teeth, 9 females--138 teeth), European derivative (31 males--304 teeth, 43 females--497 teeth) and Mongoloid populations (12 males--166 teeth, 19 females--252 teeth). The magnitude of sexual dimorphism within each ethnic stock was also examined. Teeth from American Black males were robust. Sexual dimorphism was unambiguous in all groups although a hierarchical order existed from the highly dichotomous American Black sample to the more homogeneous European sample. The female dental phenotype was down-scaled from their male counterparts, but not gracile in form. Easily obtained area and shape parameters derived from dental radiographs proved useful as discriminators among racial groups and the sexes. The relationships among these data lend further support to the hypothesis of an African origin of modern humans.     

‘We've got team spirit!’: ethnic community building and Japanese American youth basketball leagues

This article examines the role co-ethnic youth basketball leagues play in shaping ethnic community among third- and fourth-generation Japanese American youth. With dwindling rates of Japanese immigration, increased rates of out-marriage, and fewer cultural hubs available, finding a thriving ethnic community has become a particular challenge for later-generation Japanese Americans. Drawing from ethnographic data, I argue that even among highly ‘assimilated’ Japanese Americans, youth basketball leagues serve as an active space for constructing and preserving ethnic community and social networks. I demonstrate how through social, cultural, and spatial interactions facilitated by sports, some Japanese Americans have found a sense of ethnic ‘connectedness’ within basketball leagues while performing their own renditions of ethnic identity that is simultaneously attentive to fluid local and global connections. These findings illuminate the role and importance of sport through which Japanese Americans challenges the racial contours of American-ness and belonging while claiming their place, locally, nationally, and transnationally.     

Cognitive changes across the menopause transition: A longitudinal evaluation of the impact of age and ovarian status on spatial memory

Cognitive changes that occur during mid-life and beyond are linked to both aging and the menopause transition. Studies in women suggest that the age at menopause onset can impact cognitive status later in life; yet, little is known about memory changes that occur during the transitional period to the postmenopausal state. The 4-vinylcyclohexene diepoxide (VCD) model simulates transitional menopause in rodents by depleting the immature ovarian follicle reserve and allowing animals to retain their follicle-deplete ovarian tissue, resulting in a profile similar to the majority of perimenopausal women. Here, Vehicle or VCD treatment was administered to ovary-intact adult and middle-aged Fischer-344 rats to assess the trajectory of cognitive change across time with normal aging and aging with transitional menopause via VCD-induced follicular depletion, as well as to evaluate whether age at the onset of follicular depletion plays a role in cognitive outcomes. Animals experiencing the onset of menopause at a younger age exhibited impaired spatial memory early in the transition to a follicle-deplete state. Additionally, at the mid- and post- follicular depletion time points, VCD-induced follicular depletion amplified an age effect on memory. Overall, these findings suggest that age at the onset of menopause is a critical parameter to consider when evaluating learning and memory across the transition to reproductive senescence. From a translational perspective, this study illustrates how age at menopause onset might impact cognition in menopausal women, and provides insight into time points to explore for the window of opportunity for hormone therapy during the menopause transition period. Hormone therapy during this critical juncture might be especially efficacious at attenuating age- and menopause- related cognitive decline, producing healthy brain aging profiles in women who retain their ovaries throughout their lifespan.     

Hot Flash,Hot Topic: Conceptualizing Menopausal Symptoms From a Cognitive-Behavioral Perspective

While most healthy women report that the menopausal transition is nondistressing, a subset of women does report that symptoms significantly interfere in their lives. The most common reason that women seek treatment during this time is for vasomotor symptoms, namely, hot flashes and night sweats. Research has suggested that reports of distress during flashing are only weakly related to more objective measures of the flash, including duration and frequency and that differences in treatment-seeking during the menopausal transition may be better accounted for by differences in symptom awareness mediated by a variety of personality and stress factors. This paper discusses hot flashes and night sweats from a cognitive-behavioral perspective, taking into account individual difference variables that may also affect the experience of menopausal symptoms.Terms such as menopause, menopausal transition, perimenopause and postmenopause have been used interchangeably with determination of reproductive status based primarily on age and symptoms. The Stages of Reproductive Aging Workshop (STRAW; Soules et al., 2001) set out to provide a better 7-level staging system to describe midlife reproductive status in healthy women. The new staging system takes into account menstrual cyclicity, endocrine changes, fertility, signs/symptoms in other organs, and uterine/ovarian anatomy. The staging system is anchored around the permanent cessation of menses (final menstrual period; FMP), with stages –5 to –3 characterizing the early, peak, and late reproductive period, –2 and –1 representing the early and late menopausal transition and +1 and +2 indicating postmenopause. Vasomotor symptoms are the most common and tend to increase in intensity in stages –1 and +1.     

Physical Activity and Reduced Intra‐abdominal Fat in Midlife African‐American and White Women

The purpose of our study was to determine whether self‐reported physical activity (PA), including recreational, household, and exercise activities, is associated with intra‐abdominal fat (IAF) in community‐dwelling white and black midlife women. We performed a cross‐sectional study of 369 women from the Chicago site of the Study of Women's Health Across the Nation (SWAN) ancillary study, the SWAN Fat Patterning Study. PA level was the independent variable, and IAF, assessed by computerized tomography (CT) scan, was the dependent variable. Measures were obtained at SWAN Fat Patterning Baseline visit between August 2002 and December 2005. Linear regression models explored the association between PA and IAF. The first model included IAF as the outcome and total score PA as the main predictor, adjusting for total percent fat mass, age, and ethnicity. The second model included education, parity, sex hormone–binding globulin (SHBG) level, and depressive symptoms, measured by Center for Epidemiological Studies‐Depression (CES‐D) scale. Each 1‐point higher total PA score was associated with a 4.0 cm² lower amount of IAF (P = 0.004), independent of total percent fat mass, age, ethnicity, SHBG level, educational level, CES‐D, and parity. Associations did not differ between white and black women. This study demonstrates a significant negative association between PA and IAF independent of multiple covariates in midlife women. Our findings suggest that motivating white and black women to increase PA during midlife may lessen IAF, which may have a positive impact on subsequent development of diabetes and cardiovascular disease.