participants were asked about their symptoms using the term“hotto furasshu”(a
term borrowed from the English term“hotflash”), to 17.1% with the termhoteri(a
term the author reported as meaning“feeling hot orflushed”). (Melby 2005 ).
Further study to elucidate cultural and ethnic differences in self-reported measures
of hotflashes is still needed.
Some research has investigated whether the physiologic measurement of hot
flashes varies across ethnic groups. One study compared hotflash experience and
physiologic measurement among women living in Puebla, Mexico, to that of women
living in Massachusetts (Sievert et al. 2002 ; Leidy 1997 ; Sievert 2007 ). Although the
Mexican women were more likely to report experiencing hotflashes as originating
on the back of the neck (100 vs. 40%) compared with women in Massachusetts, the
optimal site for skin conductance measurement of hotflashes between the two
groups did not differ between nuchal and sternal sites (Sievert 2007 ). Three different
skin conductance measurement sites (sternum, upper arm, and upper back) were also
investigated among white and black women living in Pittsburgh. This study sup-
ported the use of the sternum as the optimal skin conductance sampling site to
measure hotflashes in the two groups (Thurston et al. 2010 ,2011a). Further, ethnic
and cultural differences in concordance rates between physiologic and subjective
measures have also been investigated. In a comparative study of concordance rates
between physiologic and self-reported hotflashes measures, a higher mean score for
true-positive hotflashes (hotflash SCL derived with corroborating self-report) was
found for the Mexican (n= 13) versus the North American (n= 15) women (61 vs.
29%,p= 0.06), and there was a significantly higher mean score for false-negative
(self-report without corroborating SCL-derived hotflash) measures in the North
American women versus the Mexican women (57 vs. 21%,p= 0.04). Though these
results are suggestive, small sample size and lack of replication in alternate cultural
samples limit interpretation (Sievert 2007 ).
In sum, existing research documents marked ethnic and cultural differences in
the overall rates of reported hotflashes, as well as the experience of hotflashes.
Furthermore, ethnic and cultural differences may impact the results of self-report
data on diaries and questionnaires. The limited data that exist suggest that current
practices in the physiologic measurement of hotflashes appear valid across the
ethnic groups, yet further international validation is needed. In sum, the phe-
nomenology of hotflashes varies markedly by ethnic group and further develop-
ment of measures valid across race/ethnicity is warranted to investigate these
important group differences.
Body Mass Index
The role of adiposity in hotflashes and their reporting has been a topic of great
interest. Adipose tissue has been thought to provide some measure of protection
against hotflashes. It was thought that the peripheral conversion of androgens to
estrone in body fat would, in turn, decrease hotflashes. However, epidemiologic
244 W.I. Fisher and R.C. Thurston