The SWAN STUDY: Gender, Identity and Menopause

I sit opposite Lila [1], the 25-year-old research assistant, in a small room at a satellite office of Mass General Hospital. She is warm and professional, and we have already discovered that she went to college at the same university where I went to graduate school. She took classes with some of my favorite professors, and we may have been in the same room at one point, when I came back to give a talk on campus. This is a nice ice-breaker. But now, in this room, Lila is in the driver’s seat. She has just finished asking me a load of questions about my health, lifestyle, and social networks. I will be there a total of four hours by the time I complete the entire process, which includes a bone density scan and a few other tests they’ve added this year.

In 1996, right after I completed my Ph.D. in Sociology, I was randomly selected as one of 3,302 women from diverse racial/ethnic backgrounds to participate in this mid-life women’s health study called SWAN – or Study of Women's Health Across the Nation. The study is following women as we transition through menopause, to better understand the physical, biological, psychological and social changes we experience during this period. SWAN aims to help scientists, health care providers and women “learn how mid-life experiences affect health and quality of life during aging”. [2]

SWAN participants or “subjects” were all between 42 and 52 years old “at baseline” – that, is, when the study began – and we represent seven cities around the country, including my own city of Boston.

When I got the call inviting me to join the SWAN study, I had just completed a lengthy project that involved a lot of interviewing. I welcomed the opportunity to answer someone else’s questions! It also felt great to be a part of important research that had the prospects of influencing medical science. But when I said "yes" to participating in SWAN nearly 20 years ago, I could not have predicted that I would be interviewed by at least 10 or more 20-something research assistants, most of them en route to medical school following this "real-life" experience. 


Last year, there was a funding hiatus for the study. I was having a tough year myself and barely noticed that I hadn’t gotten my annual call to set up an appointment. Then a month ago, a letter arrived. SWAN was back in biz, and I’d be getting a call soon! I was thrilled that the study was re-funded in this era of budget cuts for basic science and social science research. I was also feeling grateful that my health was back on track. It struck me that SWAN gave me a regular opportunity to reflect on my life’s circumstances, and to think about how I’m handling growing older, even if it’s only because of a series of questions read to me by a young research assistant whom I've just met.

Lila was trained to draw blood, and as she jabs me with the needle, I think, wow, she’s pretty good. We continue to chat, as she measures my waist and hips, clocks how fast I can walk down the narrow hallway, and how long I can balance in a variety of different positions. I'm feeling pretty cocky, until we get to the cognitive test, which they instituted about four years ago. Even though I think my memory is pretty good, being quizzed by a millennial is unnerving. I tell Lila that this test makes me anxious, and she says “yeah, everyone hates it”. That’s only somewhat reassuring, but I appreciate her attempt to normalize my response. Once it’s over – after I spat back a series of numbers and letters in order, and re-told a story about three children in a burning house being saved by a brave fire fighter – I tell myself, “good enough”. That was something my father used to say in moments of stress.

The SWAN Study has taken care to ensure that we are a diverse sample of participants.

Prevalence of hot flashes by race/ethnicity

In Boston, researchers over-sampled African-American women, meaning that the study has intentionally included a larger percentage of African-Americans than are represented in the general population. Other cities have ensured that the sample includes large numbers of Chinese, Japanese, and Hispanic women. This oversampling strategy allows researchers to investigate the influence of race and ethnicity on health outcomes of women as we age.

SWAN-affiliated researchers, Drs. Robin Green and Nanette Santoro, found that most symptoms of menopausal women varied by ethnicity. They write,

“Vasomotor symptoms were more prevalent in African-American and Hispanic women and were also more common in women with greater BMI, challenging the widely held belief that obesity is protective against vasomotor symptoms”.

They also found that vaginal dryness was present in 30-40 percent of SWAN participants at baseline, and was most prevalent in Hispanic women. But even among Hispanic women, “symptoms varied by country of origin”. The researchers conclude that “acculturation appears to play a complex role in menopausal symptomatology” and that “ethnicity should be taken into account when interpreting menopausal symptom presentation in women”.

By including an ethnically diverse sample, the SWAN Study is able to compare the experiences of women from varied backgrounds, which has pointed to important differences that should be of great benefit to health care practitioners. Moreover, SWAN researchers provide participants with information about our health, and flag issues we should explore further. For example, I discovered that I had high cholesterol, something that runs in my family. I’m now being monitored by a specialist, who asked me to take a very lose dose of a Statin. And overall, I’m more conscientious about my diet. The upshot is that my cholesterol levels are under control.

Gathering the SWANS...

Jocelyn Elders, former U.S. Surgeon General

In the past couple of decades, the SWAN team held a number of gatherings to bring Boston SWAN “subjects” together. It's awesome to be in a room with hundreds of women with one thing in common: we are mid-life women who have gone through menopause! What fun to talk about all the crap we are experiencing without feeling judged or worrying that we might be boring someone.

The first gathering I attended offered workshops where “experts” could answer our questions about sleep (like hot flashes keeping us awake) or provide us with alternatives to Hormone Replacement Therapy. One year, SWAN researchers organized an event that featured the brilliant and outspoken Jocelyn Elders, former U.S. Surgeon General who was a lightning rod for speaking her mind, in support of legalizing marijuana, the distribution of contraceptives in schools, and even suggesting that masturbation might be a means of preventing young people from engaging in riskier forms of sexual activity. Sitting in a diverse crowd of mid-life women and cheering for Elders, whom I have admired for years, was positively thrilling.

Lila tells me a little about this year’s gathering, which I unfortunately missed. I learn that one of the Boston-based Principal Investigators, Dr. Joel Finkelstein, is a serious art aficionado and at the last SWAN Study gathering, he showed a series of paintings by an older woman. His message was that we can continue to grow and be creative as we age. When the interview is complete, Lila hands me my gift. In past years, it has been a cup or a small tote bag, marked with the graceful SWAN logo. But this year, it’s a small box, the top graced with a floral design from this artist.

Gift from SWAN Study

In the abstract of his 2014 application to the National Institutes of Health, Dr. Finkelstein concluded by saying, “SWAN will fill important gaps in understanding the impact of the menopausal transition and mid-life aging on women's health and functioning in the postmenopausal years. Accordingly, it will provide useful information to guide clinical decisions in mid-life and beyond in women who have diverse life experiences and socioeconomic and racial/ethnic characteristics”.

I'm grateful to be a part of this longitudinal study, to know that the aggregate data being collected reflects a diverse population of women, and that we are collectively contributing to scientific knowledge that can improve the lives of women as we age.

Finally, here’s a great clip from Menopause, the Musical!, just for fun:  https://www.youtube.com/watch?v=ndFBFXV3jjs

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[1] Fictitious name
[2] The SWAN Study is co-sponsored by the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), the National Institutes of Health (NIH), Office of Research on Women's Health, and the National Center for Complementary and Alternative Medicine.

Sociologists in the Policy Arena: A Conversation with Tekisha Everette

My first job in Boston was working for Senator Jack Backman, a progressive state Senator who headed up the Human Services Committee on Families and Elder Affairs.  I was considered his “child and family expert”, but I hardly felt like an expert, particularly in that shark tank of policymaking.  I loved and hated that job, the daily tedious business of writing legislation, sitting for hours in meetings, taking orders as the lowest of the low on that totem pole. But I learned how to analyze a state budget, and how bills get passed, and who makes decisions behind which closed doors. I also learned that I wasn’t suited to moving things from inside the system, but I loved being an outsider trying to make the system move. 

Senator Backman sponsored the first universal child care bill in the state, arguing that all children should have access to early childhood education. While this seems laudable now, at the time it was laughable because people felt it was so “out there”, beyond anything that was remotely possible. This was the early 80s, and while women had already been entering the labor force in droves, some politicians were just getting used to it. 

The Governor, a rabid right-wing demagogue, vociferously argued against increasing child care subsidies to poor families, much less even considering universal child care policy. His famous line was that “child care is a Cadillac service”, a “luxury” that the state could not afford, particularly because it was women’s place to stay at home to care for their families. It took several decades for Massachusetts and 39 other states to finally implement universal pre-kindergarten (UPK).

The most compelling part of my job was working with a ferociously committed group of early childhood teachers who fought for more funding for child care programs, including funds to increase child care worker wages. Since my role was as a liaison to a liberal Senator, they lobbied me to take up their cause. Initially I felt flattered that they were trying to convince me to support their issues, but I soon realized that I was "one of them", except that I had some leverage to help them get access to key legislators. 

It was from this group of amazing early childhood education advocates that I learned about the need for government subsidies to defray the high cost of child care for low- and middle-income parents. It was from them that I learned about the high turnover of child care workers because of their low wages - and the negative impact of teacher turnover on the quality of care to children. Not too soon after I left that job, I became a lobbyist for a statewide child care association.

Recently, I organized a panel for the Sociologists for Women in Society winter meeting, and as I looked for speakers who could demonstrate the wide range of jobs that sociologists have in the “applied world”, I discovered Tekisha Everette, a brilliant Sociologist who, at the time, was working as a lobbyist with the American Diabetes Association. Tekisha spoke about why she chose to be an Applied Sociologist, the substance of what she actually does in her job on a day-to-day basis as a lobbyist, and how she incorporates a race/gender/class lens in talking with policymakers about public health issues. Having worked in the policy world, I was particularly moved by how Tekisha uses her scholarship as a sociologist, incorporating analyses of how race, gender and class affect public health policy issues. Here’s a snippet of our conversation: 

Mindy:  Tekisha - why did you choose to do Applied Sociology?

Tekisha: I chose Applied Sociology because I wanted to combine my educational background – political science, policy and sociology – to affect change in society. I wanted to go beyond studying society to applying that knowledge to drive policy change in society. 

M:  Can you tell me a bit about the types of applied jobs you have held?

T:  I am a lobbyist now but I’ve been policy analyst and a liaison between state government employees and a firm of economists. In each position, I have used my research skills as well as my sociological theoretical lens to execute my work. For me, this has been an amazing experience because I am relevant in a variety of spaces and I can alter my voice and perspective based on what is needed in the situation. 

M:  How would you describe the role you play within the organization’s structure?

T:  I am the lead lobbyist for my organization and I lead a team of three lobbyists and one manager. I provide strategic leadership on policy and legislative efforts of the Association. I also serve as a member of senior management for the department and help shape a number of our projects and priorities. Since most, if not all, of our initiatives have to be evidence-based, I spend a fair amount of time reviewing, requesting, and explaining research to support our legislative ideas. 

M:  What does the work of a lobbyist entail?

T:  Interacting with Members of Congress and their staff, the White House and federal agencies, training and helping our advocates to use their experience to gain support for legislative proposals, reading/reviewing research and translating it into policy. 

M:  How do you incorporate a sociological lens in your work?

T:  Since I have come to my organization, there have been a number of times where I've been able to bring a sociological lens to affect decision-making. Overall, I think I have worked to change the way we make decisions to ensure that we take a variety of backgrounds and various interests into account. Being a sociologist gives me the advantage of being able to go beyond the data and making it relevant to policymakers in ways they can understand. My goal is to always be sure I can explain the impact of policy at a localized level - and to incorporate the impact from a gender, race and class perspective.

M:  What drives you to do this work?

T:  I believe that you have to be a able to explain anything you do to your grandma! Perfecting the art of being able to use research and explain it to a variety of audiences is important to me.

Tekisha has just accepted a new position to become the inaugural Executive Director of Health Equity Solutions in Connecticut. The organization is a non-profit focused on addressing health equity issues in Connecticut through public policy, education and advocacy activities. She begins her new position in May, as she takes on another opportunity to have an impact in the policy arena!

Being an Applied Sociologist: A Conversation with Chantal Hailey

When attempting to transform communities through social policy, it is imperative to not only understand what the social problem is, but also how and why it exists and persists. Trained sociologists have indispensable tools for this type of applied work. - Chantal Hailey

                                                                    

                                                                                                               

In my last blog post – Choosing Applied Sociology – I referred to a 2013 article in Inside Higher Ed in which Sociologist Roberta Spalter-Roth, from the American Sociological Association, comments that “In sociology, there is close to a perfect match between available jobs and new Ph.D.s”, if you take into account non-academic jobs (https://www.insidehighered.com/news/2013/08/06/sociology-job-market-continues-recover-steadily). She notes that while these “applied” jobs often pay more than university teaching positions, graduates rarely know about them and professors may even discourage their students from entering these professions. 

Unfortunately, the majority of Sociology grad students view the tenure-track job market as their only career choice, but there are many Sociologists who have chosen to work in applied settings. The skills gleaned through a Sociology degree are applicable - or dare I say, "marketable" - in a whole host of other venues, including government, corporations, and all sizes of nonprofits, local, state and national. We are researchers, lobbyists, program managers, teachers/trainers, and more.

I decided to organize a panel on this topic at the annual meeting of Sociologists for Women in Society, held in Washington, DC.  And on February, 2015, three distinguished Applied Sociologists from the DC area presented about why they chose this route of practice, what they do and for which populations, and how they incorporate sociological principles into their work, framed by a race, class, gender lens.  In this post, one of the speakers, Chantal Hailey, talks about her draw to applied work, which she began as a Sociology student at Howard University. After a number of years doing Applied Sociology, Chantal is now a first year doctoral student at New York University.

Mindy:  What interested you in doing applied work?

Chantal:  Throughout out my childhood, I lived, attended summer camps and had friends and family who lived in low-income urban neighborhoods. I was able to see how low-quality schools, subpar housing, limited opportunities and violence shaped young peoples’ lives and limited their potential. I had a passion to transform these communities into places where all people could thrive. But on the other hand, I was a nerd. I enjoyed research, history, math and statistics. 

During my internship at a research branch of a community development corporation, I discovered that providing statistical trends on health, education, and housing to nonprofits could help them inform how they served low-income communities. I also discovered that the voices of women and people of color were sometimes absent from these discussions. I knew that in order to get a seat at the table, as a black woman, I needed to have the highest credential possible. So I began my academic journey at Howard University (as an) undergraduate in the Sociology department, knowing that my ultimate goal was to complete a doctoral degree in Sociology. 

Mindy: Did you know you were learning about Applied Sociology at that point?

Chantal:  While I was at Howard, I didn't know of any distinction between applied and "pure" sociology.  I just completed papers on topics that were important to me--public housing, poverty, and education. Urban Institute (UI) kept popping up in my literature reviews and I applied for internship there after my junior year. 

Mindy:  What did you do when you were at Urban Institute?

Chantal:  At Urban Institute (UI), I transformed from an intern to a Research Assistant to a Research Associate. UI's research is a combination of researcher-generated projects and responses to RFPs (Requests for Proposals). Two of my projects exemplify the type of applied sociology I was able to undertake at UI.  The first is the “Long Term Outcomes for Chicago Public Housing Families” project (LTO). LTO is a 10-year longitudinal study of families whose Chicago public housing was demolished or revitalized through the Plan for Transformation. We employed mixed methodology - family surveys; in-depth interviews with heads of household, young adults and children; and administrative data review. 

                                                                            

We found that after relocation from distressed public housing developments, families generally lived in better quality housing in safer neighborhoods, but many adults struggled with physical illnesses and youth suffered the consequences of chronic neighborhood violence.

Mindy:  What was your role there? What did you do?

Chantal:  As a team member in this project, I assisted in developing the survey, helped lead data analysis, generated the young adult interview guides and conducted in-depth interviews with the young people in the study. I also co-led and lead-authored research briefs on housing and neighborhood quality and youth. A research brief is a 15-20 page synopsis of research findings. Unlike most journal articles, there is not a long literature review. 

This short article allows us to disseminate the findings to wide audiences. In addition to the standard research brief, we also produced blogs, HUD online journal articles, and radio reports; and briefed the Chicago Housing Authority, Senate committee members, and the press.  LTO used sociological methods to understand policy, but intentionally shared this knowledge with wider policy makers and practitioners. 

Mindy: You say that trained Sociologists have “indispensable tools” for applied sociology. Can you elaborate on this a bit?

Chantal:   Sociology can address a plethora of subject areas that often intersect (i.e. inequality, education, crime and violence, health, etc.), and it unveils the mechanisms behind social problems. A Sociology education trains researchers to look for the hidden transcripts among social groups and interactions, not just the most apparent narrative. It allows for simultaneous macro, meso, and micro analysis to understand multiple contributing factors. And it emphasizes the impact social context has on policies’ implementation and outcomes. 

This was especially apparent in the LTO study. We understood that in addition to families’ relocation from public housing, a series of key factors – including proliferating national rates of housing foreclosure, increasing Chicago neighborhood violence, and rising income inequality – also shaped families’ experiences in South Side Chicago neighborhoods.

A Sociology education provides an array of methodological tools that can be tailored to best address research questions (i.e. interviews, focus groups, ethnography, quantitative analysis).  It pairs theories of race, class, family structure, etc. to better understand social issues. These analytic and research skills allow us to partner with government, non-profit, and academic agencies to both advance sociological theory and offer practical solutions to social problems.

Mindy:  Thank you!  And can you provide another example of applied work you’ve done, where you’ve been able to bring your analytic and research skills to the fore?

Chantal:  In D.C., I participated in a Community Based Participatory Grant funded by NIH entitled Promoting Adolescent Sexual Safety (PASS). UI, University of California San Diego, D.C. Housing Authority, and D.C. public housing residents collaborated in the PASS project.

This research team – along with a mix of individuals from different racial, class, and professional backgrounds – aimed to develop a program to increase sexual health and decrease sexual violence. 

Mindy:  How did you use what you were learning as a Sociology student/practitioner?

Chantal: Again, we used sociological methods to conduct this project, including an adult and youth survey, in-depth interviews with community members, participant observations, and focus groups. 

Mindy:  You said this project was participatory. Can you talk about who was involved?  How was it participatory?

Chantal:  Through the grant, we developed a community advisory board, a group of 15 residents who participated in creating the PASS program. The interactions between the community advisory board, community practitioners, and the researchers challenged the researchers to not only study educational, class, geographic and racial inequalities, but also to assess how our interactions dismantled or exacerbated power inequities. 

Mindy:  Earlier, when we spoke, you talked about what it was like to be an African-American researcher who also had a personal understanding of the experience of people you were researching. Can you talk a little about that?

Chantal: As an African American woman on the project with family who lived in D.C., I was personally challenged to both create distance as a researcher and closeness as a fellow black D.C. resident. I often found myself "code-switching" during community meetings, as I communicated with both my co-workers and the community members. Feeling a responsibility to and, often, sympathizing with the desires of the researchers and the residents, I also had to sometimes explain and mediate diverging understandings during conflicts. This closeness and distance dichotomy was also pertinent during data analysis. While my experiences allowed me to recognize and interpret focus group participants’ terminologies and cultural cues, I had to ensure that my sympathies with the community did not cloud my ability to see inconvenient truths. 

Mindy: And how did you get what you learned out there to your target audiences?

Chantal: This research project, like most UI projects, focused on dissemination to wider audiences in palatable formats--a community data walk, research briefs, blogs and journal articles.

 

Mindy:  Finally…now you’re a doctoral student at NYU and studying Sociology.  How do you see yourself moving forward as a Sociologist?  How will you incorporate what you’ve learned into your future practice? (or is that something you’re still figuring out!)

Chantal:  As I continue in graduate school at NYU, I aim to crystalize my research identity and trajectory. I have methodological and policy research experience through the Urban Institute, and I am gaining theoretical expertise while completing my doctoral degree. I hope to incorporate these elements into my research and become a conduit between academia, policy makers, and urban communities to make inner city neighborhoods a place where all children can thrive. A mentor once advised me that graduate school is a journey where you begin in one place and end in another. I am tooled with amazing applied experiences and I’m excited to see how my graduate school journey directs my path.