Ann Intern Med. 2011 Jan 18;154(2):77-84.

Houston TK , Allison JJ , Sussman M , Horn W , Holt CL , Trobaugh J , Salas M , Pisu M , Cuffee YL , Larkin D , Person SD , Barton B , Kiefe CI , Hullett S .

the Center for Healthcare Quality, Outcomes, and Economic Research, eHealth Quality Enhancement Research Initiative, and Bedford Veterans Affairs Medical Center, Bedford, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; Cooper Green Mercy Hospital and University of Alabama at Birmingham, Birmingham, Alabama; University of Maryland, College Park, Maryland; University of Pennsylvania, Philadelphia, Pennsylvania; and AstraZeneca, Wilmington, Delaware.

Abstract

Background: Storytelling is emerging as a powerful tool for health promotion in vulnerable populations. However, these interventions remain largely untested in rigorous studies. Objective: To test an interactive storytelling intervention involving DVDs. Design: Randomized, controlled trial in which comparison patients received an attention control DVD. Separate random assignments were performed for patients with controlled or uncontrolled hypertension. (ClinicalTrials.gov registration number: NCT00875225) Setting: An inner-city safety-net clinic in the southern United States. Patients: 230 African Americans with hypertension. Intervention: 3 DVDs that contained patient stories. Storytellers were drawn from the patient population. Measurements: The outcomes were differential change in blood pressure for patients in the intervention versus the comparison group at baseline, 3 months, and 6 to 9 months. Results: 299 African American patients were randomly assigned between December 2007 and May 2008 and 76.9% were retained throughout the study. Most patients (71.4%) were women, and the mean age was 53.7 years. Baseline mean systolic and diastolic pressures were similar in both groups. Among patients with baseline uncontrolled hypertension, reduction favored the intervention group at 3 months for both systolic (11.21 mm Hg [95% CI, 2.51 to 19.9 mm Hg]; P = 0.012) and diastolic (6.43 mm Hg [CI, 1.49 to 11.45 mm Hg]; P = 0.012) blood pressures. Patients with baseline controlled hypertension did not significantly differ over time between study groups. Blood pressure subsequently increased for both groups, but between-group differences remained relatively constant. Limitation: This was a single-site study with 23% loss to follow-up and only 6 months of follow-up. Conclusion: The storytelling intervention produced substantial and significant improvements in blood pressure for patients with baseline uncontrolled hypertension. Primary Funding Source: Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation.

In recent years, research on menopausal symptomalogy has focused on identifying symptom groupings experienced by women as they progress from premenopausal to postmenopausal status. However, most of these studies have been conducted among Caucasian women from western cultures. This leaves open the question of whether the findings from these studies can be extended to women of other racial/ethnic groups or cultures. Furthermore, many of the previous studies have been conducted on relatively small samples. This paper addresses the diversity of the menopause experience by comparing symptom reporting in a large cross-sectional survey of women aged 40–55 years among racial/ethnic groups of women in the United States (Caucasian, African-American, Chinese, Japanese, and Hispanic). Evaluation of the extent to which symptoms group together and consistently relate to menopausal status across these five samples provides evidence for or against a universal menopausal syndrome. The specific research questions addressed in this paper are: (1) How does the factor structure of symptoms among mid-aged women compare across racial/ethnic groups? (2) Is symptom reporting related to race/ethnicity or menopausal status? and (3) Does the relation between menopausal status and symptoms vary across racial/ethnic groups?

Analyses are based on 14,906 women who participated in the multi-ethnic, multi-race, multi-site study of mid-aged women called the Study of Women’s Health Across the Nation (SWAN). Study participants completed a 15-min telephone or in-person interview that contained questions on a variety of health-related topics. Items of interest for these analyses include symptoms, menstrual history (to assess menopausal status), health status, and sociodemographics.

Factor analysis results showed that across all five racial/ethnic groups, two consistent factors emerged; one consisting of clearly menopausal symptoms — hot flashes and night sweats — and the other consisting of psychological and psychosomatic symptoms. Results of regression analyses showed racial/ethnic differences in symptom reporting, as well as differences by menopausal status. Controlling for age, education, health, and economic strain, Caucasian women reported significantly more psychosomatic symptoms than other racial/ethnic groups. African-American women reported significantly more vasomotor symptoms. Perimenopausal women, hormone users, and women who had a surgical menopause reported significantly more vasomotor symptoms. All of these groups, plus postmenopausal women, reported significantly more vasomotor symptoms than premenopausal women. The pattern of results argues against a universal menopausal syndrome consisting of a variety of vasomotor and psychological symptoms.

Nancy E. Avis^a, Rebecca Stellato^a, Sybil Crawford^a, Joyce Bromberger^b, Patricia Ganz^c, Virginia Cain^d and Marjorie Kagawa-Singer^e
a New England Research Institutes, 9 Galen Street, Watertown, MA 02472, USA
^b Departments of Epidemiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
^c University of California at Los Angeles, School of Medicine, Los Angeles, CA, USA
^d Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MA, USA
^e University of California at Los Angeles, School of Public Health, Los Angeles, CA, USA

Corresponding author. Tel.: +1-617-923-7747 ext. 310; fax: +1-617-926-8246; email: nancya@neri.org

Social Science & Medicine
Volume 52, Issue 3, February 2001, Pages 345-356