title: Women's midlife health across cultures: DAMES comparative analysis.
abstract: OBJECTIVE
  The Decisions At Menopause Study (DAMES) investigates the experience of menopause in four countries. This article explores self-reported health.
  
  
  METHODS
  Women aged 45 to 55 years were interviewed in Lebanon (n=298), Morocco (n=299), Spain (n=300), and the United States (n=293). The survey instrument included closed- and open-ended questions. Statistical analyses were used to assess the determinants of reporting poor health, and textual analyses were used to highlight themes related to perceptions of health.
  
  
  RESULTS
  In Lebanon and Morocco, 22% and 28%, respectively, of the women sampled indicated that their health was not good. In Spain and the United States, 15% and 11% of the women sampled reported their health as fair or poor. We explored significant predictors of poorer reported health across sites. Responses to the open-ended questions "How is your health?" and "How do you compare your health to other women your own age?" revealed common concerns of aches and pains, tiredness, work/responsibilities, and family across all four sites. Unique themes included the war in Lebanon, poverty in Morocco, and social activity in Spain. Menopausal symptoms may in many cases be overshadowed by other health concerns of middle-aged women. Nonspecific symptoms such as tiredness and aches and pains serve to link bodily health with social circumstances. Family and work responsibilities are common concerns of middle-aged women.
  
  
  CONCLUSIONS
  Research on midlife health and menopause needs to be systematic enough to enable cross-cultural comparisons. At the same time, it must be flexible enough to identify population-specific symptoms, social context, and lifestyle concerns.
authors.affiliation: Department of Anthropology, Emory University, Atlanta, GA 30322, USA. mschul2@emory.edu
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Parsons
authors.forename: Carla Makhlouf
authors.initials: CM
authors.lastname: Obermeyer
mesh_terms: D000328:Adult; D003431:Cross-Cultural Comparison; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007861:Lebanon / Q000453:epidemiology / Q000208:ethnology; D008593:Menopause / Q000208:ethnology* / Q000523:psychology; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology / Q000208:ethnology; D011788:Quality of Life; D013030:Spain / Q000453:epidemiology / Q000208:ethnology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D016387:Women's Health