title: How well do different measurement modalities estimate the number of vasomotor symptoms? Findings from the Study of Women's Health Across the Nation FLASHES Study.
abstract: OBJECTIVE
  Studies of vasomotor symptoms (VMS) typically measure VMS via daily diaries completed at the end of the day. VMS can also be measured via diaries completed throughout the day or via physiological monitors-modalities with lower recall demands. We examined the degree of correspondence between three VMS measurement modalities: retrospective end-of-day/morning diaries, prospective reporting, and physiological monitoring. We determined whether discrepancies between measurement modalities varied by participant characteristics.
  
  
  METHODS
  Twenty-five African-American women and 27 white women from the Pittsburgh site of the Study of Women's Health Across the Nation who were experiencing VMS, had intact uterus and ovaries, and were free of medications affecting VMS underwent 4 days of ambulatory VMS and Actiwatch monitoring. VMS were recalled in end-of-day and morning diaries, reported prospectively during the day, and measured physiologically via a hot flash monitor. Associations between anxiety, sleep, or race/ethnicity and VMS measurement modality difference scores were examined using generalized estimating equations.
  
  
  RESULTS
  Women underestimated the number of daytime VMS at the end of the day as compared with VMS that were prospectively reported or physiologically measured throughout the day. This pattern was particularly pronounced among African-American women (b [SE] = -3.01 [0.93], P = 0.001) and women with higher anxiety (b [SE] = -3.13 [1.53], P = 0.04). For nighttime VMS, women overestimated the number of VMS in the morning upon waking as compared with prospective measures, particularly if they had poorer sleep (higher wakening after sleep onset: b [SE] = 0.03 [0.008], P = 0.001).
  
  
  CONCLUSIONS
  Different measurement modalities yield different VMS estimates. Negative affect, sleep, and race/ethnicity may affect the recall of VMS.
authors.affiliation: From the 1Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; 2Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; 3Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; and 4Department of Psychology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Polly
authors.initials: P
authors.lastname: Fu
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Thurston
mesh_terms: D001741:Black or African American; D001007:Anxiety; D005188:False Negative Reactions; D005260:Female; D019584:Hot Flashes / Q000175:diagnosis*; D006801:Humans; D008499:Medical Records; D008593:Menopause; D011939:Mental Recall; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010414:Pennsylvania; D012890:Sleep; D011795:Surveys and Questionnaires; D044465:White People; D016387:Women's Health