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The purpose of this secondary analysis was to determine the clusters of midlife women by gastrointestinal (GI) symptoms and to explore differences in the clusters by race/ethnicity. This analysis used the data from two internet-based studies among 1,054 midlife women. The analysis was conducted with the data on background characteristics, health and menopausal status, and GI symptoms (collected using the GI Symptom Index for Midlife Women). The data were analyzed using factor analyses, hierarchical cluster analyses, chi-square tests, multinomial logistic regression analyses, and analyses of covariance. Three clusters were adopted: Cluster 1 (with low total numbers and severity scores of symptoms; 46.0%), Cluster 2 (with moderate total numbers and severity scores of symptoms; 44.0%), and Cluster 3 (with high total numbers and severity scores of symptoms; 10.0%). Only in Cluster 2, there were significant racial/ethnic differences in individual GI symptoms. These results provide directions for future GI symptom management among midlife women.

Many studies have been conducted to investigate the effect of cultural influences on menopausal symptoms; however, associations between immigration transition and cognitive symptoms have rarely been uncovered. This secondary analysis aimed to determine these associations among 1,054 midlife women in the United States using the data from two national Internet surveys. The surveys included multiple questions on immigration transition, health and menopausal status, and the Cognitive Symptom Index for Midlife Women. The data analysis was performed using descriptive and inferential statistics including hierarchical multiple regression analyses. Nonimmigrants had larger numbers and higher severity scores of total cognitive symptoms than immigrants ( p < .001). Immigration status explained 1.28% of the total variances in the total numbers and 1.46% of the total variances in the total severity scores of total cognitive symptoms ( p < .001). The study supported significant associations between immigration transition and cognitive symptoms of women at midlife.

Menopausal transition, in which biological and psychosocial changes are caused due to estrogen fluctuations, has been reported to increase cardiovascular risk among midlife women. The purposes of this study were to identify the clusters of midlife women by cardiovascular symptoms and to examine racial/ethnic differences in the clusters. This was a secondary analysis, in which hierarchical cluster and multinomial logistic analyses were conducted with the data (N = 966) collected in two previous studies. Three clusters were adopted: Cluster 1 (high vasomotor and low cardiorespiratory), Cluster 2 (low vasomotor and high cardiorespiratory and high discomfort/pain), and Cluster 3 (high discomfort/pain and high indigestion).

The transition due to immigration from one country to another country (referred to as immigration transition henceforth) is inherently stressful, placing an additional dimension of stress to midlife women in the menopausal transition. However, few studies have examined the association of immigration to sleep-related symptoms experienced by midlife women in the menopausal transition. The authors' purpose for this study was to explore the associations of immigration to sleep-related symptoms among four major racial/ethnic groups of 1,054 midlife women in the United States. This was a secondary analysis of data from two national surveys that were collected from 2005 to 2013. The instruments included questions on background characteristics, health and menopausal status, immigration transition, and the Sleep Index for Midlife Women. The data were analyzed using t-tests, chi-square tests, correlation analyses, and hierarchical multiple regression analyses. Immigrants reported fewer total numbers of and lower total severity scores of sleep-related symptoms than non-immigrants (p < .01). Yet, when background characteristics and health and menopausal status were controlled, self-reported racial/ethnic identity was the only significant factor associated with sleep-related symptoms (ΔR 2  = 0.02, p < .01). Health-care providers need to consider self-reported racial/ethnic identity as a factor significantly related to sleep-related symptoms during the menopausal transition.

Objectives: To identify racial/ethnic differences in perceived health status and differences in the factors associated with perceived health status of midlife women in four broad racial/ethnic groups in the United States., Design: A secondary analysis of Web-based survey data., Setting: Internet communities/groups among midlife women and Internet communities/groups of racial/ethnic minorities., Participants: Participants included 491 women 40 to 60 years of age who self-identified into four broad racial/ethnic categories (Hispanic, non-Hispanic [N-H] Asian American, N-H African American, or N-H White)., Methods: Data related to participants' sociodemographic, behavioral, situational, and individual health factors and their coping resources were selected based on the Comprehensive Health Seeking and Coping Paradigm. Multiple logistic regression analyses were used to identify racial/ethnic differences in perceived health status and race/ethnicity-specific factors associated with perceived health status among midlife women., Results: Perceived health status did not differ by race/ethnicity; however, factors that were associated with perceived health status did vary by race/ethnicity. Among N-H White women, educational level, level of family income, obesity, and menopausal symptoms were significantly associated with perceived not healthy status. In Hispanic women, perceived level of physical activity and obesity were significantly associated with not healthy status. Perceived level of physical activity was the only factor significantly associated with not healthy status in N-H Asian American women, and the level of family income was the only factor associated with not healthy status in N-H African American women., Conclusion: In future intervention development, researchers need to consider differences among racial/ethnic groups in the factors associated with women's perceived health status., (Copyright © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to identify clusters of midlife women by sleep-related symptoms in multiethnic groups and to examine racial/ethnic differences in the clusters., Methods: This secondary analysis was conducted on data from 1,054 midlife women who participated in two cross-sectional descriptive national Internet surveys. The instruments included questions on background characteristics, health, and menopause status, and the Sleep Index for Midlife Women. The data were analyzed using hierarchical clustering methods, χ2 test, analysis of variance, and multinomial logistic regression analyses., Results: A four-cluster solution was adopted: cluster 1 (low total symptoms group), cluster 2 (moderate physical and psychosomatic symptoms group), cluster 3 (moderate psychological symptoms group), and cluster 4 (high total symptoms group). There were significant differences in education, employment status, family income, social support, country of birth, race/ethnicity, body mass index, perceived general health, diagnosed disease, access to health care, and menopause status among clusters (P < 0.05). In cluster 1 only, there were significant racial/ethnic differences in the total number of total severity scores for physical symptoms (P < 0.01). When racial/ethnic differences in individual symptoms in each cluster were determined, there were no consistent racial/ethnic differences., Conclusions: Researchers need to consider that racial/ethnic differences could be prominent in midlife women with low sleep-related symptoms.

Ethnic minority midlife women frequently do not recognize cardiovascular symptoms that they experience during the menopausal transition. Racial/ethnic differences in cardiovascular symptoms are postulated as a plausible reason for their lack of knowledge and recognition of the symptoms. The purpose of this study was to explore racial/ethnic differences in midlife women's cardiovascular symptoms and to determine the factors related to these symptoms in each racial/ethnic group. This was a secondary analysis of the data from a larger study among 466 participants, collected from 2006 to 2011. The instruments included questions on background characteristics, health and menopausal status, and the Cardiovascular Symptom Index for Midlife Women. The data were analyzed using inferential statistics, including Poisson regression and logistic regression analyses. Significant racial/ethnic differences were observed in the total numbers and total severity scores of cardiovascular symptoms (p < .01). Non-Hispanic Asians had significantly lower total numbers and total severity scores compared to other racial/ethnic groups (p < .05). The demographic and health factors associated with cardiovascular symptoms were somewhat different in each racial/ethnic group. Further studies are needed about possible reasons for the racial/ethnic differences and the factors associated with cardiovascular symptoms in each racial/ethnic group.

The purpose of this study was to explore the relationships between immigration transition and depressive symptoms among 1,054 midlife women in the United States. This was a secondary analysis of the data from two national Internet survey studies. Questions on background characteristics and immigration transition and the Depression Index for Midlife Women were used to collect the data. The data were analyzed using inferential statistics including multiple regressions. Immigrants reported lower numbers of symptoms and less severe symptoms than nonimmigrants (p <.01). When controlling for background characteristics, self-reported racial/ethnic identity and immigration status were significant predictors of depressive symptoms (R(2) =.01, p <.05).

Objectives: To explore Asian American midlife women's attitudes toward physical activity using a feminist perspective., Design: A qualitative online forum study., Settings: Internet communities/groups for midlife women and ethnic minorities., Participants: A total of 17 Asian American women recruited through the Internet using a convenience sampling method., Methods: A 6-month qualitative online forum was conducted using 17 online forum topics. The data were analyzed using thematic analysis., Results: Three major themes related to Asian American midlife women's attitudes toward physical activity were extracted from the data: keeping traditions, not a priority, and not for Asian girls. Because Asian American midlife women were busy in keeping their cultural traditions, they rarely found time for physical activity. The women gave the highest priority to their children, and physical activity was the lowest priority in their busy lives. Also, the women were rarely encouraged to participate in physical activity during their childhoods, and they perceived that their weak and small bodies were not appropriate for physical activity., Conclusions: Several implications for future development of physical activity promotion programs for this specific population have been suggested based on the findings., (© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Purpose: This study aimed to explore the menopausal symptom experiences of Asian American midlife women within the contexts of their daily lives using a feminist approach., Design: This was a qualitative online forum study among 13 Asian American women recruited through the Internet. Seven discussion topics related to the menopausal symptom experience were used, and the data were analyzed using thematic analysis., Findings: Five themes emerged: (a) “being conditioned,”(b) “becoming strong,” (c) “appreciating,” (d) “without making a fuss,” and (e) “quiet support.” DISCUSSION, CONCLUSION, AND IMPLICATIONS FOR PRACTICE: These themes represent the women’s marginalized but empowered experience duringmenopausal transition.

Objective: To describe the experience of menopausal symptoms of midlife Black women in the United States., Design: Qualitative online forum using a feminist perspective., Setting: Internet communities for midlife women and Blacks., Participants: Twenty midlife Black women recruited using a quota sampling method., Methods: A 6-month online forum was conducted with seven discussion topics on menopausal symptoms. The discussion topics were posted sequentially on the forum site, and the women posted messages at their convenience over 6 months. The data were analyzed using thematic analysis., Results: The identified themes were raised to be strong, accepting a natural aging process, silent and without knowledge, and our own experience. The women tried to be strong during their menopausal transitions while dealing with other important family matters. The women did not report their menopausal symptoms and were silent about or downplayed their symptoms, but many emphasized the importance of education about menopausal symptoms and highlighted their own lack of knowledge. These women generally did not talk about their symptoms because they believed that nobody except other Black midlife women could understand their menopausal experience., Conclusion: Health care providers need to develop a mechanism to deliver the necessary knowledge about menopausal symptoms and management strategies to Black midlife women in their health care practices.

The purpose of the study was to explore ethnic differences in symptoms experienced during the menopausal transition among four major ethnic groups in the United States. This study was done via a cross-sectional Internet survey among 512 midlife women recruited using a convenience sampling. The instruments included questions on background characteristics, ethnicity-related factors, health, and menopausal status and the Midlife Women's Symptom Index. The data were analyzed using descriptive and inferential statistics. Significant ethnic differences were found in the total number and severity of the symptoms. The most frequently reported symptoms and predictors of the total number and severity of the symptoms differed by ethnic identity. More in-depth cultural studies are needed to understand the reasons for the ethnic differences in menopausal symptom experience.

Purpose: To compare the menopausal symptom experiences of subethnic groups of Asian American midlife women., Design: A cross-sectional study among 91 Asian American women online. Questions about background characteristics, ethnic identity, and health and menopausal status, and the Midlife Women's Symptom Index were used. The data were analyzed using descriptive and inferential statistics., Findings: The most frequently reported and the most severe symptoms differed by subethnicity. The total number of symptoms differed by subethnicity, as did total severity scores for the symptoms., Discussion: Researchers and clinicians should be aware of subethnic differences.

My purpose in this study was to explore ethnic differences in symptoms experienced during the menopausal transition among four major ethnic groups in the United States using a feminist perspective. This was a cross-sectional correlational study among 158 midlife women. The instruments included are questions on sociodemographic characteristics, health, and menopausal status, and the Midlife Women's Symptom Index (MSI). The data were analyzed using descriptive and inferential statistics. Significant ethnic differences in the total number of symptoms (p < .01) were found. The most frequently reported symptoms differed by ethnicity. The symptoms experienced during the menopausal transition were significantly associated with some contextual factors.

Our purpose in this article is to review theories critically that have been used to explain immigrant women's health based on 4 case studies of Korean immigrant women's experiences in the United States and suggest directions for future development of theories on immigrant women's health. First, 3 existing theories on immigration and health (selective migration, negative effect of immigration, and acculturation) are concisely described. Then, the daily experiences of 4 low-income Korean immigrant women are described in a narrative mode, and the 3 existing theories are critiqued in terms of how they can explain the women's narratives. Finally, implications for future theory development on immigrant women's health experience are proposed based on the discussion.

In this article, the Midlife Women's Symptom Index (MSI), a recently developed measurement scale for symptoms experienced during the menopausal transition, is presented with its psychometric properties. This was a cross-sectional study including (a) an expert review among 20 women's health experts and (b) a psychometric test among 77 middle-aged women. The instruments for the psychometric test were 19 questions on sociodemographic characteristics, the MSI, and the Menopausal Symptom Checklist (MSC). Data were analyzed using descriptive statistics, K-R 20, and item analysis. The reliability and validity of the MSI were supported among middle-aged women.

The purpose of the study was to determine comparability of an Internet format to a Pen-and-Pencil (PP) format of the Midlife Women's Symptom Index (MSI). This study utilized a cross-sectional comparative design with three sections: (a) a PP survey among 77 middle-aged women; (b) an Internet survey among 81 middle-aged women; and (c) an expert review among 20 women's health experts. Both of the PP and the Internet surveys included sociodemographic questions, the MSI, and the Menopausal Symptom Checklist. Data were analyzed using descriptive statistics, K-R20, and correlation coefficients. The findings supported the reliability and validity of both Internet and PP formats of the MSI.

Internet Cancer Support Groups (ICSGs) are an emerging form of support group on Internet specifically for cancer patients. Previous studies have indicated the effectiveness of ICSGs as a research setting or a data-collection method. Yet recent studies have also indicated that ICSGs tend to serve highly educated, high-income White males who tend to be at an early stage of cancer. In this article, a total of 317 general ICSGs and 229 ethnic-specific ICSGs searched through Google.com, Yahoo.com, Msn.com, AOL.com, and ACOR.org are analyzed from a feminist perspective. The written records of group discussions and written memos by the research staff members were also analyzed using content analysis. The idea categories that emerged about these groups include (a) authenticity issues; (b) ethnicity and gender issues; (c) intersubjectivity issues; and (d) potential ethical issues. The findings suggest that (a) researchers adopt multiple recruitment strategies through various Internet sites and/or real settings; (b) researchers raise their own awareness of the potential influences of the health-related resources provided by ICSGs and regularly update their knowledge related to the federal and state standards and/or policies related to ICSGs; and (c) researchers consider adopting a quota-sampling method.

Because a limited amount of women's health research using Internet-based data collection methods has been done, very little is known about the methodological and ethical issues that are unique to this emerging research practice. The purpose of this article is to inform the future directions of Internet usage in women's health research based on the practical issues raised in an Internet survey of 62 midlife Asian women in the United States. The issues include (a) potential selection biases, (b) ethical concerns, (c) a low response rate, (d) frequent consultations, and (e) potential data entry errors. Based on the discussion of the issues, future directions for Internet research are proposed.

There is a paucity of models that drive integrated research agendas, and coherent approaches to development and progress of knowledge about women's health. In this article, we review four major models of women's health, present conditions supporting more integrative and coherent models of women's health based on the recommendations by two international conferences, and address major paradoxes inherent in women's health areas. For integrative and coherent models of women's health, we propose to incorporate visions and insights of previous models in developing a more coherent model that includes three major components-integration, transition, and marginalization.

Purpose: To propose gender-sensitive theories as a future direction for theoretical development of women's health. Few theories pertain to women's health and illness experiences, with gender issues embedded in social, cultural, and historical contexts., Organizing Construct: Significance, definition, and philosophical bases of gender-sensitive theories., Findings: Six major components should be incorporated in the development of gender-sensitive theories: (a) gender as a major feature, (b) women's own words and experiences, (c) nature of women's experiences, (d) theorists' perspectives, (e) contexts, and (f) guidelines for actions., Conclusions: We believe that the development of gender-sensitive theories in nursing could enable researchers to transcend androcentric and ethnocentric views on women's health, decrease gender inequity in health care, enhance women's well being, and ultimately contribute to knowledge development in nursing.

Purpose: To describe how Korean immigrant women tend to describe their work experiences within their daily lives and how they relate their work to the symptoms experienced during midlife., Design: Cross-sectional study using methodological triangulation. Using a convenience sampling method, 119 Korean immigrant women were recruited for the quantitative phase, and 21 among the 119 women were recruited for the qualitative phase. Data were collected using both questionnaires and in-depth interviews. The data were analyzed using descriptive and inferential statistics and thematic analysis. FINDINGS AND DISCUSSIONS: The symptoms that the women experienced during midlife were influenced by their work experience, which was complicated by their cultural heritage, gender issues embedded in their daily lives, and immigration transition., Implications: Complexities and diversities in women's work need to be incorporated in menopausal studies.

Research on women's work and health largely has failed to incorporate gender into the models of the processes through which work influences well-being. In this article, the research on women's work and health is critiqued from a feminist perspective; male-oriented and ethnocentric views on women's work are negated, and gender and socioeconomic issues are highlighted and included in the picture of women's work. Male-centered and ethnocentric views and assumptions on women's work are prevalent in the whole research process, and methodological limitations due to the distorted views are indicated. Based on the critique, some implications for future research on women's work and health are proposed.