Once a vaccine for coronavirus disease 2019 becomes available, it will be important to maximize vaccine uptake and coverage. This national survey explores factors associated with vaccine hesitancy. The results suggest that multipronged efforts will be needed to increase acceptance of a coronavirus disease 2019 vaccine.

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An unprecedented number of women will experience menopause in the next decade. Although the timing of menopause affects long-term disease risk, little is known about factors that affect this timing. In the present 1995--1997 cross-sectional study, the Study of Women's Health Across the Nation, the relation of demographic and lifestyle factors to age at natural menopause was examined in seven US centers and five racial/ethnic groups. All characteristics were self-reported by women aged 40--55 years (n = 14,620). Cox proportional hazards models were used to estimate the probability of menopause by age. Overall, median age at natural menopause was 51.4 years, after adjustment for smoking, education, marital status, history of heart disease, parity, race/ethnicity, employment, and prior use of oral contraceptives. Current smoking, lower educational attainment, being separated/widowed/divorced, nonemployment, and history of heart disease were all independently associated with earlier natural menopause, while parity, prior use of oral contraceptives, and Japanese race/ethnicity were associated with later age at natural menopause. This sample is one of the largest and most diverse ever studied, and comprehensive statistical methods were used to assess factors associated with age at natural menopause. Thus, this study provides important insights into this determinant of long-term disease risk in women.

IMPORTANCEThe expected duration of menopausal vasomotor symptoms (VMS) is important to women making decisions about possible treatments.OBJECTIVES To determine total duration of frequent VMS (Ն6 days in the previous 2 weeks) (hereafter total VMS duration) during the menopausal transition, to quantify how long frequent VMS persist after the final menstrual period (FMP) (hereafter post-FMP persistence), and to identify risk factors for longer total VMS duration and longer post-FMP persistence. DESIGN, SETTING, AND PARTICIPANTSThe Study of Women's Health Across the Nation (SWAN) is a multiracial/multiethnic observational study of the menopausal transition among 3302 women enrolled at 7 US sites. From February 1996 through April 2013, women completed a median of 13 visits. Analyses included 1449 women with frequent VMS. MAIN OUTCOMES AND MEASURESTotal VMS duration (in years) (hot flashes or night sweats) and post-FMP persistence (in years) into postmenopause. RESULTSThe median total VMS duration was 7.4 years. Among 881 women who experienced an observable FMP, the median post-FMP persistence was 4.5 years. Women who were premenopausal or early perimenopausal when they first reported frequent VMS had the longest total VMS duration (median, >11.8 years) and post-FMP persistence (median, 9.4 years). Women who were postmenopausal at the onset of VMS had the shortest total VMS duration (median, 3.4 years). Compared with women of other racial/ethnic groups, African American women reported the longest total VMS duration (median, 10.1 years). Additional factors related to longer duration of VMS (total VMS duration or post-FMP persistence) were younger age, lower educational level, greater perceived stress and symptom sensitivity, and higher depressive symptoms and anxiety at first report of VMS.CONCLUSIONS AND RELEVANCE Frequent VMS lasted more than 7 years during the menopausal transition for more than half of the women and persisted for 4.5 years after the FMP. Individual characteristics (eg, being premenopausal and having greater negative affective factors when first experiencing VMS) were related to longer-lasting VMS. Health care professionals should counsel women to expect that frequent VMS could last more than 7 years, and they may last longer for African American women.

OBJECTIVES This prospective study examined if changes in traditional and novel coronary heart disease (CHD) risk factors are greater within a year of the final menstrual period (FMP), relative to changes that occur before or after that interval, in a multi-ethnic cohort. BACKGROUND Understanding the influence of the menopause on CHD risk remains elusive and has been evaluated primarily in Caucasian samples. METHODS The Study of Women’s Health across the Nation (SWAN) is a prospective study of the menopausal transition in 3302 minority (African American, Hispanic, Japanese, or Chinese) and Caucasian women. After 10 annual exams, 1054 women had achieved a FMP not due to surgery and without HT use prior to FMP. Measured CHD risk factors included lipids and lipoproteins, glucose, insulin, blood pressure, fibrinogen, and C-reactive protein. We compared which of two models provided a better fit to the observed risk factor changes over time in relation to FMP: a linear model, consistent with chronological aging, or a piece-wise linear model, consistent with ovarian aging. RESULTS Only total cholesterol, LDL-C, and apolipoprotein-B demonstrated substantial increases within the 1 year interval before and after FMP, consistent with menopause-induced changes. This pattern was similar across ethnic groups. The other risk factors were consistent with a linear model, indicative of chronological aging. CONCLUSIONS Women experience a unique rise in lipids at the time of FMP. Monitoring lipids in perimenopausal women should enhance primary prevention of CHD.

Younger breast cancer survivors are at risk for impaired QOL up to several years after diagnosis. Younger women, especially those at high risk for lower QOL, may need interventions that specifically target their needs related to menopausal symptoms and problems with relationships, sexual functioning, and body image. Preparing younger woman for the impact of breast cancer may also prove beneficial.

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Women diagnosed with breast cancer at a younger age often have concerns less frequently faced by older women. A cross-sectional survey of 204 women diagnosed with breast cancer at age 50 or younger within the past 3.5 years was conducted to examine issues particularly faced by younger women. The questionnaire included standardized measures of problems related to breast cancer (CARES) and open-ended questions asking women about their experiences. Concerns about premature menopause and pregnancy related issues, among those women for whom these issues were applicable, had the highest ratings as problems experienced by women since their diagnosis. Among all women, sexual functioning was a greater problem than lack of sexual interest, and body image was of moderate concern. Overall, relationships with partners were not a problem. In multivariate analyses, having a mastectomy was associated with greater problems with body image and interest in sex. Chemotherapy was associated with greater sexual dysfunction. Responses to open-ended questions were particularly informative and reflected the diversity of responses women have to breast cancer. Findings reinforce the need to develop interventions to help women deal with premature menopause and problems with sexual functioning following chemotherapy.