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Women may experience a decline in physical function during menopause. Whether this decline is due to aging or to changes in hormonal status is unknown. The authors performed a longitudinal data analysis on data collected between 1996 and 2001 to determine the effects of menopausal status, age, race, and use of hormone replacement therapy (HRT) on 3-year changes in grip and pinch strength. Participants were 563 women from the Chicago, Illinois, site of the Study of Women's Health Across the Nation. According to adjusted analyses, women who became postmenopausal showed a 1.04-kg decline in grip strength (p = 0.10) and a 0.57-kg decline in pinch strength (p = 0.002) relative to women who remained premenopausal. Women who became early perimenopausal showed a 0.20-kg decline in pinch strength (p = 0.04), whereas women who transitioned to late perimenopause showed a 0.93-kg decline in grip strength (p = 0.07). Effects of menopausal status on grip and pinch strength did not vary by race. A significant HRT-by-race interaction for grip strength was found; African-American HRT users had greater grip strength during the study, whereas Caucasian HRT users did not (p = 0.05). Greater physical activity was the strongest predictor of grip and pinch strength (p < 0.0001). Results indicate that transition through menopause is associated with a decline in grip and pinch strength. [ABSTRACT FROM AUTHOR]

Background: Patients treated for hypothyroidism with levothyroxine (LT4) monotherapy may present with persistent hypothyroidism symptoms, including cognitive symptoms, despite having a normal thyroid stimulating hormone (TSH) level. It remains unclear whether LT4 monotherapy is sufficient to normalize cognitive function outcomes over time. Methods: This is a multisite longitudinal study of a diverse group of women during midlife representing 5 ethnic/racial groups from 7 enrollment sites across the United States in the Study of Women's Health Across the Nation. Women were screened for a history of thyroid disease and the use of LT4. The study consisted of two primary groups: women with LT4-treated hypothyroidism and control women without thyroid disease. Each participant completed up to 9 cognitive assessments over the study period testing processing speed, working memory, and episodic memory (immediate and delayed recall). Multivariable generalized linear mixed models of scores for each cognitive assessment were developed to determine the association between LT4-treated hypothyroidism and cognitive function trajectories. Covariates included sociodemographic, clinical characteristics, and menopausal status (pre/early peri, late peri, and surgical/post). Sensitivity analyses were conducted to assess the impact of abnormal TSH levels and practice effects (i.e., improvements in scoring after repeated testing). Results: Of the 2033 women who were included in the study, 227 (11.2%) met criteria for LT4-treated hypothyroidism. At baseline, both processing speed and working memory scores were higher in LT4-treated women (mean processing speed scores: 56.5 vs 54.4; p value = 0.006; mean working memory scores: 6.8 vs 6.4; p value = 0.018). However, when considering the effect of LT4-treated hypothyroidism over time, there were no significant differences in the rate of cognitive decline (in any measure) between the hypothyroidism and control groups with or without covariate adjustment. The results were similar when considering LT4-treated women with abnormal TSH levels or after minimizing practice effects. Conclusions: We observed no difference in cognitive decline between women with LT4-treated hypothyroidism and women without thyroid disease. For similar aged patients with cognitive complaints, if thyroid function testing is normal, clinicians should consider causes other than inadequate thyroid hormone treatment to explain these symptoms.

Background: Randomized behavioral clinical trials are the gold standard for evaluating efficacy of a behavioral treatment. However, because participants are generally unblinded to treatment, preference for a specific treatment option can lead to biased results and/or reduced treatment efficacy. The purpose was to describe the relative frequency and correlates of existence of a preference and patient preference for either an in-person group-based or a remote self-directed, lifestyle treatment prior to randomization to one of these treatments., Methods: The Enhanced Lifestyles for Metabolic Syndrome (ELM) trial is a multi-site behavioral clinical trial that compares efficacy of a group-based vs. a self-directed approach to lifestyle change on 2-year remission of the metabolic syndrome. Prior to randomization, participants were asked whether they had a preference for a particular treatment and, if so, which approach they preferred. Baseline data were used for a series of logistic regression models to determine behavioral correlates of treatment preference, independent of socioeconomic factors., Results: Of the 331 participants, 131 (39.6%) had no preference for either treatment. Among the 200 with a preference, 56 (28.0%) preferred the self-directed program. Strength of a pre-existing habit of eating vegetables on most days was an independent correlate of no preference (adjusted OR, 1.27; 95% CI, 1.01-1.61; p = 0.03) and preference for a self-directed program (adjusted OR, 1.55; 95% CI, 1.09-2.22; p = 0.01)., Conclusion: A pre-existing habit of eating vegetables was associated with no preference and preference for a less intensive lifestyle treatment. Post-treatment follow-up of the trial results will determine if concordance between preference and treatment assignment influences outcomes., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objectives: To determine whether physical function (PF) before menopause is related to cardiovascular disease (CVD) risk., Methods: Participants were N = 2950 pre-/early peri-menopausal women (median age 46, (25th-75th percentile: 43-48 years). Physical function was assessed at baseline using the Physical Function subscale of the SF-36 and scores were trichotomized (no, some, or substantial limitations). Clinical CVD events were ascertained at annual/biennial clinical assessments through the 15th follow-up visit. Risk of CVD was determined with Cox proportional hazards models. Results: Women were followed for a median of 19.1 years, during which 220 women had a CVD event. In fully adjusted models, women with substantial limitations at baseline had higher CVD risk compared to women with no limitations (hazards ratio [HR] = 1.55, 95% confidence interval [CI]: 1.12-2.33). Discussion: Substantial PF limitations in pre- and early peri-menopausal women are associated with higher risk of clinical CVD events, consistent with literature in older adults.

Objectives: Research has shown a link between childhood sexual abuse (CSA) and lower urinary tract and sexual disorders in clinical settings. We examined whether CSA was associated with two specific aspects of high tone, elevated resting tension pelvic floor dysfunction (PFD) in community-dwelling women. Materials and Methods: Data were from 2068 participants (25.5% Black, 9.6% Chinese, 10.8% Japanese, 5.0% Hispanic, and 49.1% Non-Hispanic White) in the Study of Women's Health Across the Nation (SWAN), a multirace/multiethnic longitudinal observational study of women's midlife health. At baseline, enrolled women were 42-52 years old and premenopausal or early perimenopausal. Annual or biennial assessments conducted over 20 years (1996 through 2017) included single-item queries about urgency urinary incontinence and pain with sexual activity used to assess PFD outcomes. The 12th follow-up visit conducted in 2009-2011 assessed the primary exposure, history of CSA, using a single-item response. Multivariate logistic regression models tested study objectives. Results: The prevalence of CSA was 15%, self-reported in 313/2068 women. CSA and PFD, both pain with sexual activity (odds ratio [OR] = 1.56 confidence interval [95% CI = 1.12-2.18]) and urgency urinary incontinence (OR = 1.87 [95% CI = 1.29-2.71]), were significantly associated in unadjusted models. The final adjusted model that included sociodemographic variables and physical and behavioral risk factors was significant for pain with sexual activity (OR = 1.48 [95% CI = 1.08-2.02]), but not for urgency urinary incontinence (OR = 1.38 [95% CI = 0.96-1.98]). Conclusions: In midlife women, pain with sex, but not urgency urinary incontinence, was associated with a history of CSA. A multidisciplinary diagnostic and therapeutic approach to PFD is key, inclusive of CSA screening.

Purpose: This study examined whether employment status during mid-life and older adulthood is associated with physical function impairment., Methods: Participants were 2700 women in the multiracial/multiethnic Study of Women's Health Across the Nation. Time-varying, lagged, and cumulative exposure analyses modeled associations between self-reported employment status and the likelihood of severe physical function impairment across 19 years of follow-up., Results: Independent of demographic variables, women who were not working (OR = 1.58, 95% CI = 1.22, 2.04) or employed part-time (OR = 1.29, 95% CI = 1.04, 1.61) were more likely to report severe physical function impairments than women employed full-time. This same pattern was seen in lagged analyses predicting risk of physical function impairment from employment status at the prior assessment (not working vs. full-time: OR = 1.53, 95% CI = 1.08, 2.18; part-time vs. full-time: OR = 1.53, 95% CI = 1.17, 2.00). The likelihood of severe physical function impairment increased by 20% for every additional 10% of follow-up spent not working (OR = 1.02, 95% CI: 1.01, 1.03). Associations were robust to adjustment for health-related variables, body mass index, and physical activity., Conclusions: Women with lower levels of employment from mid-life to older adulthood were more likely to experience severe impairment in physical function. However, the underlying mechanisms, and the timescales over which associations unfold, require further study., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: In patients undergoing regadenoson SPECT myocardial perfusion imaging (MPI), the prognostic value of ischemic ST-segment depression (ST↓) and the optimal ST↓ threshold have not been studied., Methods: A retrospective cohort study of consecutive patients referred for regadenoson stress MPI was conducted. Patients with uninterpretable ECG were excluded. Two diagnostic thresholds of horizontal or downsloping ST↓ were studied, ≥ 0.5 mm and ≥ 1.0 mm. The primary endpoint was the composite major adverse cardiac events (MACE) of cardiac death, myocardial infarction, or coronary revascularization., Results: Among 8615 subjects (mean age 62 ± 13 years; 55% women), 89 (1.0%) had ST↓ ≥ 1.0 mm and 133 (1.5%) had ST↓ ≥ 0.5 mm. Regadenoson-induced ST↓ was more common in women (P < .001). Mean follow-up was 2.5 ± 2.2 years. After multivariate adjustment, ST↓ ≥ 1.0 mm was associated with a non-significant increase in MACE risk (P = .069), irrespective to whether MPI was abnormal (P = .162) or normal (P = .214). Ischemic ST↓ ≥ 0.5 mm was independently associated with MACE in the entire cohort (HR 2.14; CI 1.38-3.32; P = .001), whether MPI is normal (HR 2.07; CI 1.07-4.04; P = .032) or abnormal (HR 2.24; CI 1.23-4.00; P = .007), after adjusting for clinical and imaging covariates. An ST↓ threshold of ≥ 0.5 mm provided greater incremental prognostic value beyond clinical and imaging parameters (Δχ 2  = 12.78; P < .001) than ≥ 1.0 mm threshold (Δχ 2  = 3.72; P = .093)., Conclusion: Regadenoson-induced ischemic ST↓ is more common in women and it provides a modest independent prognostic value beyond MPI and clinical parameters. ST↓ ≥ 0.5 mm is a better threshold than ≥ 1.0 mm to define ECG evidence for regadenoson-induced myocardial ischemia.

Background: Body composition strongly influences physical function in older adults. Bioelectrical impedance analysis (BIA) differentiates fat mass from skeletal muscle mass, and may be more useful than body mass index (BMI) for classifying women on their likelihood of physical function impairment., Aims: This study tested whether BIA-derived estimates of percentage body fat (%BF) and height-normalized skeletal muscle mass (skeletal muscle mass index; SMI) enhance classification of physical function impairment relative to BMI., Method: Black, White, Chinese, and Japanese midlife women (N = 1482) in the Study of Women's Health Across the Nation (SWAN) completed performance-based measures of physical function. BMI (kg/m 2 ) was calculated. %BF and SMI were derived through BIA. Receiver-operating characteristic (ROC) curve analysis, conducted in the overall sample and stratified by racial group, evaluated optimal cutpoints of BMI, %BF, and SMI for classifying women on moderate-severe physical function impairment., Results: In the overall sample, a BMI cutpoint of ≥ 30.1 kg/m 2 correctly classified 71.1% of women on physical function impairment, and optimal cutpoints for %BF (≥ 43.4%) and SMI (≥ 8.1 kg/m 2 ) correctly classified 69% and 62% of women, respectively. SMI did not meaningfully enhanced classification relative to BMI (change in area under the ROC curve = 0.002; net reclassification improvement = 0.021; integrated discrimination improvement = - 0.003). Optimal cutpoints for BMI, %BF, and SMI varied substantially across race. Among Black women, a %BF cutpoint of 43.9% performed somewhat better than BMI (change in area under the ROC curve = 0.017; sensitivity = 0.69, specificity = 0.64)., Conclusion: Some race-specific BMI and %BF cutpoints have moderate utility for identifying impaired physical function among midlife women.

Background: Chronic conditions are associated with worse physical function and commonly develop during midlife. We tested whether the presence of 8 chronic conditions, or the development of these conditions, is associated with declines in physical function among midlife women as they transition into early late life., Methods: Participants ( N  = 2283) were from the Study of Women's Health Across the Nation. Physical function was assessed at 8 visits starting at the study's fourth clinic visit in 2000/2001 through follow-up visit 15 (2015/2017) using the Short Form-36 Physical Function subscale. Chronic conditions included diabetes, hypertension, osteoarthritis, osteoporosis, stroke, heart disease, cancer, and depressive symptoms. Repeated-measures Poisson regression modeled associations between 1) prevalent chronic conditions at analytic baseline (visit 4) and longitudinal physical function, and 2) change in physical function associated with developing a new condition. Models were adjusted with the total number of other chronic conditions at visit 4., Results: In separate fully-adjusted longitudinal models, prevalent heart disease and osteoporosis were associated with 18% (IRR = 0.815, 95% confidence interval [CI]: 0.755-0.876) and 12% (IRR = 0.876, 95% CI: 0.825-0.927) worse initial physical function, respectively. Prevalent osteoarthritis was associated with approximately 6% (IRR = 0.936, 95% CI: 0.913-0.958) worse initial physical function, and a slight additional worsening over time (IRR = 0.995, 95% CI: 0.994-0.996). A 12% (IRR = 0.878, 95% CI: 0.813-0.950) decrease in physical function concurrent with stroke development was evident, as was accelerated decline in physical function concurrent with heart disease development (IRR = 0.991, 95% CI: 0.988-0.995)., Conclusions: Initial prevalent conditions related to the musculoskeletal system were associated with worse initial physical function, with some evidence of accelerated decline in physical function with osteoarthritis. Stroke and heart disease are less common than osteoarthritis in this age group, but the severe effects of these conditions on physical function shows the need for a greater focus on cardiovascular health during midlife. Women who develop chronic conditions during midlife may be at particular risk for poor physical function as they age, warranting disability prevention efforts focused on this population., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: Chronic medical conditions (CMCs) often emerge and accumulate during the transition from mid- to late-life, and the resulting multimorbidity can greatly impact physical function. We assessed the association of CMC presence and incidence on trajectories of physical function from mid- to early late-life in the Study of Women's Health Across the Nation., Methods: Physical function was assessed at eight clinic visits (average 14 years follow-up) using the physical function subscale of the Short Form-36. CMCs included osteoarthritis, diabetes, stroke, hypertension, heart disease, cancer, osteoporosis, and depressive symptomatology, and were considered cumulatively. Repeated-measures Poisson models estimated longitudinal change (expressed as percent difference) in physical function by chronic CMCs. Change-points assessed physical function change coincident with the development of a new condition., Results: Women (N = 2,283) followed from age 50.0 ± 2.7 to 64.0 ± 3.7 years; 7.3% had zero CMCs through follow-up, 22.5% (N = 513) had no baseline CMCs but developed ≥1, 22.7% women had ≥1 baseline CMC but never developed another, and 47.6% had ≥1 baseline CMC and developed ≥1 more. Each additional baseline CMC was associated with 4.0% worse baseline physical function and annual decline of 0.20%/year. Women with more baseline CMCs had greater decline in physical function with a new CMC (-1.90% per condition); and annual decline when developing a new condition accelerated by -0.33%/year per condition., Conclusions: Self-reported physical function changes are evident from mid- to early late-life with the development of CMCs. Preventing or delaying CMCs may delay declines in physical function, and these potential pathways to disability warrant further research., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The aim was to describe the early phases of the progressive development of a lifestyle treatment for sustained remission of the metabolic syndrome (MetS) using the Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development as a guide., Methods: Early discovery and design phases produced a 3-component (diet, physical activity, stress), group-based lifestyle treatment with an intensive 6-month phase followed by monthly, participant-led maintenance meetings. In the proof-of-concept phase, 26 participants with the MetS (age 53 ± 7 years, 77% female, and 65% ethnic minority) were recruited in a quasi-experimental design to determine if treatment could achieve the prespecified benchmark of MetS remission in ≥50% at 2.5 years. Exploratory outcomes focused on MetS components, weight, and patient-centered benefits on energy/vitality and psychosocial status., Results: MetS remission was achieved in 53.8% after a median of 2.5 years. At 2.5 years, an increase of +15.4% reported eating ≥3 servings of vegetables/day, +7.7% engaged in ≥150 minutes of moderate-to-vigorous physical activity/week; and +11.5% reported experiencing no depression in the past 2 weeks. Weight loss ≥5% was achieved by 38.5%, and energy/vitality, negative affect, and social support improved. Median group attendance over 2.5 years was 73.8%., Conclusions: It is plausible that this lifestyle program can produce a remission in the MetS, sustained through 2.5 years. After refinements to enhance precision and strength, progression to feasibility pilot testing and a randomized clinical trial will determine its efficacy as a cost-effective lifestyle option for managing the MetS in the current health care system. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Background: Asthma disproportionately affects minority youth. Understanding the home medication environment and its relation to medication adherence can shape interventions to improve health outcomes., Objective: The objective of this study was to describe the asthma medication environment in the homes of urban minority youth and to determine predictors of medication use and technique in this population., Methods: Baseline data from 2 cohorts of minority youth with asthma in Chicago were combined for cross-sectional analysis. Bilingual research assistants (RAs) collected data in the home. RAs asked caregivers and children to self-report medications using pictures and observed children's asthma medications and inhaler technique., Results: The sample contained 175 mainly Latino youth (85.6%) ranging from 5 to 18 years old. Most were on public insurance (80%) and had uncontrolled asthma by self-report (89.7%). Only 27.4% had a spacer, 74.9% had a quick relief medicine, and 48.6% had any controller medicine. RA observations of controllers agreed with children (36%) and parental self-report (42.3%) but did not match the specific observed controllers. Children reported less parental help with medications (43%) than their parents (58.1%). One child was able to properly demonstrate 100% of the inhaler steps and 35.6% achieved >70% of inhaler steps. A better medication technique was associated with having a controller (b = 12.2, SE = 3.0, P < .0001), quick reliever (b = 8.05, SE = 3.5, P = .023), and a spacer (b = 9.3, SE = 3.54, P = .009)., Conclusions: This rigorous evaluation of the home medication environment of high-risk youth demonstrated that many families lack critical medications, devices, and a technique for proper management of asthma., (Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

African Americans experience poorer diabetes outcomes than non-Hispanic Whites. Few clinical trials of diabetes self-management interventions specifically target African Americans, perhaps due to well-documented barriers to recruitment in this population. This paper describes strategies used to successfully recruit 211 low-income African Americans from community clinics of a large, urban public hospital system to a randomized clinical trial of an 18-month diabetes self-management intervention. Diabetes-related physiological, psychosocial, and behavioral characteristics of the sample are reported. The sample was 77% female, mean age = 55, mean A1C = 8.5%, 39% low health literacy, 28.4% moderate/severe depression, and 48.3% low adherence. Participants ate a high-fat diet with low vegetable consumption. Relative to males, females had higher BMI, depression, and stress, and better glycemic control, less physical activity, and less alcohol consumption. Males consumed more daily calories, but females consumed a greater proportion of carbohydrates. Gender-specific diabetes self-management strategies may be warranted in this population.

Background: Physical inactivity in midlife women is associated with increased intra-abdominal adipose tissue development. We describe an innovative multimethod study 1) to better understand barriers to physical activity (PA) and 2) to engage midlife women to product test physical activities and identify local community-based providers and sustainable and fun PA experiences., Methods: Formative research on PA barriers from the Chicago site Study of Women's Health Across the Nation (SWAN) ancillary study of midlife women was used to develop a pilot testing measure. Feasibility, acceptability and sustainability of the PA activities were determined using the measure., Results: Desirable locations and/or instructors were identified. The first 2 groups identified, pilot tested, and then ranked activities for their ability to promote sustained PA. The 6 top-ranked were: circuit training, total body fitness, kickboxing, Zumba, Pilates, and pedometer. The final group pilot tested highly ranked PA in 2-week blocks, and ranked pedometer and Zumba in their top 3., Conclusion: Consensus was reached regarding activities that could be valuable in promoting sustained PA in midlife women. Choosing convenient sites and popular instructors further facilitates sustainability. Building relationships with key community partners is essential for sustainability. Community-based participant involvement in study design is a critical element in developing a healthy living intervention.

Background: The objective of this study was to design and test the feasibility and impact of a community health worker (CHW) intervention for comorbid asthma and obesity., Methods: Using a proof of concept study design, we collected pre/post outcomes from a single intervention cohort of urban low-income in a single community area. A community-based participatory research approach was employed. Forty-six children and their caregivers were recruited. Children were 5-12 years old with physician-diagnosed asthma and body mass index (BMI) > 85%. Families were offered 12 home visits from CHWs that integrated asthma and obesity core curriculums. The primary asthma outcome was asthma control, measured via the Childhood Asthma Control Test (cACT). The primary obesity outcome was child body mass index (BMI)., Results: Families received a median of 10 out of the 12 home visits over 1 year. At 1 year, there was a significant improvement in the number of children with controlled asthma as measured via cACT (85.7% at 1 year compared to 61.9% at baseline, p = 0.01). Activity limitations and emergency utilization were reduced while inhaler technique improved (p < 0.01 for all). Child BMI z-score was reduced: mean = 1.97 (SD 0.79) at 1 year compared to mean = 2.13 (SD 0.40) at baseline, p < 0.01. No association was seen between change in child BMI and change in asthma control. Worse baseline child depression scores were associated with less improvement in asthma control (p = 0.003) and higher baseline caregiver post-traumatic stress disorder scores were associated with increased child BMI (p = 0.012)., Conclusions: The CHW intervention has promise for improving asthma and weight outcomes in high-risk children with comorbid asthma and obesity; this model warrants further development and investigation.

Background: Changes in reproductive hormones during menopause are associated with accumulation of intra-abdominal adipose tissue (IAAT), a subclinical indicator of cardiometabolic disease risk. Independent of reproductive hormones, unhealthy lifestyle contributes to IAAT gain. The Women in the Southside Health and Fitness (WISHFIT) Study aims to develop a lifestyle approach to slowing IAAT accumulation as women begin the menopausal transition., Methods: The primary aim is to develop and conduct a proof-of-concept test of a multi-component, multi-level behavioral intervention targeting jointly physical activity, diet, and psychological well-being. Participants attend group sessions over 2 years to experiment with healthy living through both experiential and didactic learning, cultivate a health network, and draw on community resources to sustain change. The primary endpoint is 2-year IAAT progression, assessed using computerized tomography. Behavioral targets of treatment and secondary endpoints will be evaluated at 6, 12, 18 and 24 months. Change in social networks and community support will be assessed at 2 years., Results: WISHFIT recruited 71 pre- and peri-menopausal Caucasian and African American women (mean ± SD age = 47.6 ± 3.4 yrs; BMI = 33.6 ± 7.3 kg/m 2 ; 52% African American). Baseline IAAT was 2104.1 ± 1201.3 cm 3 . IAAT, physical activity, BMI, and self-reported family income and resilience differed by ethnicity at baseline., Conclusions: WISHFIT is a multi-component, multi-level intervention aimed at producing a sustained improvement in physical activity, diet, and psychological well-being early in the menopausal transition to slow menopause-related accumulation of IAAT. It provides a model for the process of developing a behavioral treatment to manage a chronic disease.

Objectives: The present cross-sectional study aimed to a) examine associations between measures of psychological well-being, specifically life satisfaction and life engagement, and intima media thickness, a subclinical marker of atherosclerosis; b) investigate if the interaction of psychological well-being and life events correlated with intima media thickness; and c) explore these relationships across race., Methods: A sample of 485 women (38% African American and 62% white; mean [standard deviation] age = 50.2 [2.9] years) underwent ultrasonography to assess carotid artery intima media thickness (IMT). The women completed self-report measures of life satisfaction, life engagement, and life events., Results: Average (standard deviation) IMT was 0.666 (0.10) mm. Life satisfaction showed a significant, independent, inverse relationship with IMT, after controlling for demographic, behavioral, psychological, and cardiovascular covariates (β = -0.105, p = .039), such that each 1-point higher life satisfaction score was correlated with a significant 0.008-mm lower level of mean IMT. No significant association was seen between life events and IMT (r = 0.05, p = .32), and life satisfaction did not interact with life events on IMT (β = -0.036, p = .46). No significant interaction between life satisfaction and race on IMT was observed (β = 0.068, p = .37). In contrast to life satisfaction, life engagement was not a significant correlate of IMT (r = -0.07, p = .12)., Conclusions: Life satisfaction, a measure of psychological well-being, is an important independent correlate of subclinical atherosclerosis in middle-aged women.

Objective: The principal objective of this investigation was to compare the naturalistic intra-abdominal adipose tissue (IAAT) change among black and white women during midlife., Methods: A cohort of 222 (56%) white and 171 (44%) black midlife women were investigated in the Fat Patterning Study at the Chicago site of the Study of Women's Health Across the Nation. The subjects' total body fat was assessed by dual-energy X-ray absorptiometry and IAAT by a planimetric computed tomography (at the level of L4 -L5 ) annually over up to 4 years., Results: The total body fat at initial evaluation was higher in black women (45.1% ± 8.2%) when compared with white women (41.3% ± 8.7%, P < 0.001) and did not significantly change over the longitudinal follow-up. No significant racial differences were found in the mean annualized gain of IAAT (4.4% ± 0.5%) in models adjusted for total body fat, initial IAAT, age, race, time and race interaction, physical activity, depressive symptoms, menopausal status, and menopausal hormone therapy., Conclusions: During a naturalistic observation, black and white midlife women had similar abdominal fat gain adjusted for differences in baseline adiposity. These data inform future research aimed to prevent IAAT gain during the critical midlife period of rising cardiovascular risk., (© 2015 The Obesity Society.)

Unlabelled: Abstract Objective: Puerto Rican children suffer disproportionately from asthma. Project CURA tested the efficacy of a community health worker (CHW) intervention to improve use of inhaled corticosteroids (ICS) and reduce home asthma triggers in Puerto Rican youth in Chicago., Methods: This study employed a behavioral randomized controlled trial design with a community-based participatory research approach. Medications and technique were visually assessed; adherence was determined using dose counters. Home triggers were assessed via self-report, visual inspection and salivary cotinine. All participants received education on core asthma topics and self-management skills. Participants in the CHW arm were offered home education by the CHW in four visits over four months. The attention control arm received four newsletters covering the same topics., Results: While most of the participants had uncontrolled persistent asthma, <50% had ICS at baseline. In the CHW arms, 67% of participants received the full four-visit intervention. In the Elementary school cohort (n=51), the CHW arm had lower odds of having an ICS (OR=0.2; p=0.02) at 12-months; no differences were seen in other outcomes between arms at any time point. The only significant treatment arm difference in the high school cohort (n=50) was in inhaler technique where the CHW arm performed 18.0% more steps correct at five months (p<0.01) and 14.2% more steps correct at 12 months (p<0.01)., Conclusions: While this CHW intervention did not increase the number of participants with ICS or reduce home asthma triggers, important lessons were learned including challenges to CHW intervention fidelity and the need for CHWs to partner with clinical providers.

With aging, women's bodies undergo changes that can affect body image perception, yet little is known about body image in midlife. The purpose of this study was to examine associations between body image and depressive symptoms in Caucasian and African-American midlife women from the Study of Women's Health Across the Nation (SWAN) Chicago site. Body image was measured using the Stunkard Adult Female Figure Rating Scale, and a clinically significant level of depressive symptoms was defined as Center for Epidemiologic Studies Depression Scale (CES-D) score of ≥16 (N=405; N=63 (15.6%) with clinically significant levels of depressive symptoms). Differences between perceived actual, perceived ideal, and actual body size and responses to questions concerning weight satisfaction and attractiveness were examined using logistic regression for associations with a CES-D score of ≥16. Women with body image dissatisfaction (odds ratio (OR)=1.91; p=0.04) or who perceived themselves as "unattractive" (OR=7.74; p<0.01) had higher odds of CES-D of ≥16. We found no significant difference by race. Our results were not confounded by BMI. These results suggest that midlife women with poor body image may be more likely to have clinically significant levels of depressive symptoms. Larger prospective studies are needed to better understand this association.

Background: Interventions to increase sustained physical activity are needed and should be based on proven theories., Purpose: To gain a better understanding of the correlates of sustained physical activity in midlife women, we used longitudinal epidemiologic data to investigate links between sustained physical activity and constructs advocated by three basic behavioral and social science theories: (1) self-determination, (2) social cognitive, and (3) social networks. A random sample of 90 midlife women, stratified by level of physical activity over 15 years, was selected from the Chicago cohort of the Longitudinal Study of Women's Health Across the Nation (SWAN)., Methods: Using data on self-reported physical activity collected over 15 years, women were categorized into consistently active, sporadically active, and sedentary. New data were collected on theory-relevant constructs, i.e., autonomous motivation (assessed by the Treatment Self-Regulation Questionnaire) and self-efficacy (assessed by the Self-Efficacy and Exercise Habits Survey). Every SWAN woman identified a close female friend who also completed the physical activity questionnaire., Results: SWAN women with higher autonomous motivation (p = 0.002) and higher self-efficacy (p < 0.001) were more likely to be consistently physically active in analyses adjusted for age, race, and socioeconomic status. Sixty-one percent of SWAN women with a history of consistent physical activity had a friend who is currently highly active, versus 38 and 23 % for sporadically active and sedentary women, respectively (test for trend p = 0.008)., Conclusion: In midlife women, constructs advocated by basic behavioral and social science theories were consistent with long-term patterns of physical activity behavior. Special focus should be given to these basic theories in the design of interventions to promote sustained physical activity in mid-life women.

Background: Racial disparities in breast and cervical cancer screening have been documented in African American, Hispanic, and Asian populations. Perceived discrimination may contribute to this disparity. The aim of this study was to understand the relationship between perceived everyday racial/ethnic and other discrimination and receipt of breast and cervical cancer screening in a multiethnic population of women., Methods: We analyzed data from 3,258 women participating in the Study of Women's Health Across the Nation (SWAN), a multiethnic/racial, longitudinal cohort study of the natural history of the menopausal transition conducted at seven U.S. sites. Participants completed a validated measure of perceived discrimination and reasons for believing that they were treated differently, along with Pap smears, clinical breast exams (CBE), and mammography at each follow-up period. We used multiple logistic regression for the binary outcomes of having a Pap smear, CBE, or mammogram in each of the two follow-up years, using self-reported "race discrimination" and "other discrimination" at baseline as the main predictors., Results: African American women reported the highest percentage of racial discrimination (35%), followed by Chinese (20%), Hispanic (12%), Japanese (11%), and non-Hispanic white women (3%). Non-Hispanic white women reported the highest percentage of "other" discrimination (40%), followed by Chinese (33%), African American (24%), Japanese (23%), and Hispanic women (16%). Perceived racial discrimination was not associated with reduced receipt of preventive screening, except in one fully adjusted model. Reported discrimination owing to "other" reasons, such as age or gender, was associated with reduced receipt of Pap smear (odds ratio [OR] 0.85; 95% confidence interval [CI] 0.74-0.99), CBE (OR 0.78; 95% CI 0.67-0.91), and mammography (OR 0.80; 95% CI 0.69-0.92) regardless of patient race., Conclusions: Perceived discrimination is an important issue across racial/ethnic groups and is negatively associated with receipt of breast and cervical cancer screening. This is an important issue that needs to be further explored and addressed in efforts to improve the delivery of healthcare to all groups.

Purpose of the Study: To identify needs encountered by older adult patients after hospital discharge and assess the impact of a telephone transitional care intervention on stress, health care utilization, readmissions, and mortality., Design and Methods: Older adult inpatients who met criteria for risk of post-discharge complications were randomized at discharge through the electronic medical record. Intervention group participants received the telephone-based Enhanced Discharge Planning Program intervention that included biopsychosocial assessment and an individualized plan following program protocols to address identified transitional care needs. All patients received a follow-up call at 30 days post discharge to assess psychosocial needs, patient and caregiver stress, and physician follow-up., Results: 83.3% of intervention group participants experienced significant barriers to care. For 73.3% of this group, problems did not emerge until after discharge. Intervention patients were more likely than usual care patients to have scheduled and completed physician visits by 30 days post discharge. There were no differences between groups on patient or caregiver stress or hospital readmission., Implications: At-risk older adults may benefit from transitional care programs to ensure delivery of care as ordered and address unmet needs. Although patients who received the intervention were more likely to communicate and follow up with their physicians, the absence of impact on readmission suggests that more intensive efforts may be indicated to affect this outcome.

Objectives: The body adiposity index (BAI) is a proposed alternative to the body mass index (BMI) that has shown good cross-sectional agreement with percent body fat (%BF) in validation studies. The objective of this study was to examine the ability of BAI to track adiposity change over time in a biracial sample of midlife women., Methods: African-American (n = 159) and Caucasian (n = 206) women, aged 42-60 years, at the Chicago site of the Study of Women's Health Across the Nation were followed from 2002 to 2008. BAI and BMI were calculated from measurements taken at annual assessments. %BF was quantified using whole-body dual-energy X-ray absorptiometry. Difference scores (BAI(Δ) , BMI(Δ) , and %BF(Δ) ) quantified adiposity change over a mean of 1.6 (SD = 0.7) years. Lin's concordance correlation (ρ(c) ) and Bland-Altman limits-of-agreement assessed agreement between BAI and %BF., Results: In examining adiposity change, BAI(Δ) showed poor agreement with %BF(Δ) in the overall sample (ρ(c) = 0.41), African-American women (ρ(c) = 0.36), and Caucasian women (ρ(c) = 0.43). BAI(Δ) estimated %BF(Δ) with minimal bias (+0.4%) but low precision (±6.3%BF limits-of-agreement). %BF(Δ) had weaker correlations with BAI(Δ) (rs = 0.38-0.48) than with BMI(Δ) (rs = 0.48-0.59). BAI and BMI showed similar cross-sectional associations with %BF in the overall sample and within each race (rs > 0.74)., Conclusions: We conclude that BAI is less accurate than BMI in tracking adiposity change in midlife women, and would not be a suitable replacement for BMI in most research applications involving adiposity change., (Copyright © 2012 Wiley Periodicals, Inc.)

We have previously shown that physical activity predicts intra-abdominal adipose tissue (IAT), but it is unknown whether energy intake predicts IAT independently of physical activity in a community-based, naturalistic environment. The association of energy intake with IAT was explored cross-sectionally in women, recruited between 2002 and 2005 for a study of fat patterning in midlife. IAT at L(4)-L(5) vertebral interspace was assessed by computed tomography, energy intake by the Block Food Frequency Questionnaire, and physical activity by the Kaiser Physical Activity Survey. Linear regression models were used for the principal analyses. Among the 257 women, 48% were African American and 52% were Caucasian. Women were 52 ± 3 years old, and 49% were postmenopausal. Every 500 kcal increase in energy intake was associated with a 6% higher IAT (P = 0.02), independent of physical activity (P = 0.02), after adjustment for ethnicity, menopausal status, age, smoking, income, and DXA-assessed percent body fat. Energy intake had a significant interaction with ethnicity (P = 0.02), but not with physical activity. Models using the IAT to subcutaneous abdominal adipose tissue ratio as an outcome had similar associations. In conclusion, self-reported EI was associated with preferential IAT accumulation in midlife women, independent of physical activity. This association was significantly stronger in Caucasian than African American women. Future longitudinal studies are needed to explore lifestyle predictors of IAT accumulation during the menopausal transition.

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 cm(2) 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.

Background: This study was done to determine whether physical activity at baseline is independently associated with musculoskeletal pain and fulfilling one's physical role over 3 subsequent years., Methods: Our research involved a 3-year longitudinal study of over 2400 community-dwelling, midlife women from the Study of Women's Health Across the Nation (SWAN). Measurements included baseline physical activity using the Kaiser Permanente Health Plan Activity Survey and SF-36 role-physical and bodily pain indices at each of 3 annual follow-up visits., Results: Each 1-point increase on the physical activity score was associated with a 7% greater likelihood of a high role-physical score (95% CI=1.02-1.13) and a 10% greater likelihood of a low bodily pain score (95% CI=1.04-1.17) after adjusting for age, race, menopausal status, educational level, body mass index, depressive symptoms, smoking, and chronic medical conditions. The association between physical activity level and role-physical score was eliminated in the fully adjusted model after adjustment for pain level in post hoc analysis [OR=1.04 (95% CI=0.98-1.09)]., Conclusion: This study demonstrates that women who are more physically active at midlife experience less bodily pain over time regardless of menopausal status, sociodemographics, and medical conditions. Higher physical activity level positively impacts fulfilling one's physical role; however, this is mediated by pain level.

Background: Hostility is associated with increased cardiovascular disease mortality and morbidity and may be related to subclinical atherosclerosis; less is known about this association among women and minority groups., Methods: We examined the association between hostility and intimal-medial thickening (IMT) as well as presence/absence of plaque in the carotid arteries in middle-aged white and African American women. Hostility was measured by a 13-item questionnaire and IMT and plaque were assessed by B-mode ultrasonography in 589 participants from the Chicago and Pittsburgh sites of the SWAN., Results: In age- and site-adjusted models, each 1-point increment in hostility score predicted a significant 0.0057-mm higher mean IMT (P < .0001) and 0.0081-mm higher maximum IMT (P < .0001)--effects that were identical in magnitude to each 1-year increment in age. Adjustments for race, education, body mass index, resting systolic blood pressure, and smoking diminished these associations, but they remained significant (P < or = .01). With hostility scores modeled in approximate tertiles, high scorers (> or = 6) had greater mean (P = .0005) and maximum (P = .0004) IMT than low scorers (0 or 1); moderate and low scorers did not differ (age-adjusted mean values for low, moderate, and high scorers were 0.657, 0.662, and 0.694 mm, respectively, for mean IMT; those for low, moderate, and high scorers were 0.855, 0.860, and 0.906 mm, respectively, for maximum IMT). Hostility was unrelated to presence of plaque and did not interact with race, education, smoking, and body mass index., Conclusions: Hostility is related to small but significantly greater subclinical atherosclerosis in middle-aged women; this association is not explained by traditional risk factors.

Background: Emerging evidence suggests that exposure to discrimination may be associated with atherosclerosis in African-American women, although research in this area focused on short-term rather than chronic exposure to discriminatory events., Methods: We examined the relationship between chronic exposure to multiple types of discrimination (self-reported and averaged over 5 years) and coronary artery calcification (CAC) in a sample of 181 middle-aged African-American women. Discrimination was assessed at each time point, and the presence/absence of CAC was assessed at the fifth annual follow-up examination by electron beam tomography. We hypothesized that chronic discrimination would be more strongly associated with CAC than recent discrimination and that racial/ethnic discrimination would be more strongly associated with CAC than other types of discrimination., Results: Chronic exposure to discrimination was significantly associated with the presence of CAC in unadjusted logistic regression analyses (p = .007) and after adjustment for demographics (p = .01), standard cardiovascular risk factors (p = .02), and Body Mass Index (BMI) (p = .05). In contrast, recent discrimination was only marginally associated with the presence of CAC in both unadjusted (p = .06) and fully adjusted logistic regression models (p = .08). Persistent exposure to racial/ethnic discrimination was not more strongly associated with CAC compared with other types of discrimination in either unadjusted or adjusted models., Conclusion: Chronic exposure to discrimination may be an important risk factor for early coronary calcification in African-American women. This association appears to be driven by exposure to discrimination from multiple sources, rather than exposure to racial/ethnic discrimination alone.

Background: We analyzed data from a single menstrual cycle from 630 women, aged 43 to 53 years, in the Daily Hormone Study component of the Study of Women's Health Across the Nation to determine whether hormone levels are associated with trouble sleeping as women enter the menopausal transition., Methods: Women recorded whether they had trouble sleeping the previous night. Morning urine specimens were obtained for daily determinations of levels of luteinizing hormone, follicle-stimulating hormone, estradiol metabolites (ie, estrone conjugates), and the progesterone metabolite (pregnanediol glucuronide). Women were categorized as premenopausal or early perimenopausal by bleeding patterns., Results: Average adjusted odds of reporting trouble sleeping were 29% higher in perimenopausal than in premenopausal women. The highest percentages of women in both menopausal groups reported trouble sleeping in the beginning or at the end of their cycle. After controlling for covariates, pregnanediol glucuronide level was associated with increased trouble sleeping in perimenopausal women and follicle-stimulating hormone level was associated with increased trouble sleeping in premenopausal women. Mood and vasomotor symptoms were the strongest and most consistent cocontributors to trouble sleeping., Conclusion: In this community-based sample of middle-aged women, the most trouble sleeping was observed at the beginning and end of the menstrual cycle.

Objectives: We examined the relationship between ability to speak English and receipt of Papanicolaou tests, clinical breast examinations, and mammography in a multiethnic group of women in the United States., Methods: We used longitudinal data from the Study of Women Across the Nation to examine receipt of breast and cervical cancer screening among Chinese, Japanese, Hispanic, and White women who reported reading and speaking (1) only a language other than English, (2) another language more fluently than English, or (3) only English or another language and English with equal fluency. Logistic regression was used to analyze the data., Results: Reading and speaking only a language other than English and reading and speaking another language more fluently than English, were significantly and negatively associated with receipt of breast and cervical cancer screening in unadjusted models. Although these findings were attenuated in adjusted models, not speaking English well or at all remained negatively associated with receipt of cancer screening., Conclusions: These findings suggest that language barriers contribute to health disparities by impeding adequate health communication.

Background: Overall rates of obesity have increased dramatically in the United States, yet African American women remain disproportionately represented among the overweight and obese. The excess weight observed in African American women is primarily considered a result of low socioeconomic status, but recent cross-sectional findings suggest otherwise., Methods: We examined the interactive effects of race and 3 levels of education (low [high school or less]; moderate [some college]; and high [college degree or more]) on body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) and changes in BMI over 4 years in 2019 middle-aged African American and white women from the Study of Women's Health Across the Nation (SWAN). Data were analyzed with mixed effects regression models., Results: At baseline, we observed a significant race x education interaction (estimate, -3.7; 95% confidence interval, -5.3 to -2.1; P<.001) on BMI. Compared with whites, African Americans had higher BMIs, but only at the moderate (means, 32.1 and 29.2) and highest (means, 31.5 and 27.8) level of education. At the lowest level of education, African American and white women were similar in BMI (means, 31.1 [African American] and 31.2 [white]). Body mass index increased significantly for all women over follow-up (estimate, 0.22; 95% confidence interval, 0.17 to 0.26; P<.001), but increases did not differ by race, education, or race x education. Results were unchanged after adjustment for potential confounding variables., Conclusions: For middle-aged women, racial disparities in BMI are largely patterned by education, with the greatest disparities observed at higher levels of education. The absence of significant longitudinal effects suggests that these race-education patterns are set in place and well established before midlife.